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LIBRARY  OF 

Dr.   carl  F.  W.  BODECKER 

1846-1912 

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Dr.  Henry  and  Dr.  Charles  Bddecker 

1929 


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Digitized  by  tine  Internet  Archive 

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Open  Knowledge  Commons 


http://www.archive.org/details/etiologyofosseouOOtalb 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES 


OF    THE 


HEAD,  FACE,  JAWS  AND  TEETH 

TALBOT 


THE    ETIOLOGY 


or 


Osseous  Deformities 


OF   THE 


HEAD,  FACE,  JAWS  AND  TEETH 


EUGENE   S.  TALBOT,  M.D,,  D.U.S. 

Professor  of  Dental  Surgery,  Woman's  Medical  College;  Lecturer  on  Dental  Surgery  and 
Pathology,  Rush  Medical  College,  Chicago;  Author  of  "The  Irregularities  of  the 
Teeth  and  their  Treatment";  Author  of  "  Chart  of  Typical  Forms  of  Constitu- 
tional Irregularities  of  the  Teeth";  Honorary  President  of  the  Dental  Sec- 
tion of  the  Tenth  International  Medical  Congress,  Berlin,  1890;  Member 
of    the  American  Medical   Association;    Member  of   the  Chicago 
Medical  Society;  Fellow  of  the  Chicago  Academy  of  Medicine; 
Member    of    the    American    Dental    Association;   Member 
of    the    Chicago    Dental  Club:     Honorary    Member  of 
the     Odontologischen     Gesellschaft,    Berlin,    Ger- 
many; Membre  Honoraire  de  1' Association  Gen- 
erale    des    Dentistes    de    France,    etc.,    etc. 


REVISED  AND  ENLARGED 


WITH 

FOUE  HUNDRED    AND    SIXTY-ONE    ILLUSTRATIONS 

422  OF  WHICH  ARE  ORIGINAL 


CHICAGO: 

THE  W.  T.  KEENER  COMPANY 

96   WASHINGTON  ST. 
1894 


ENTEBED  ACCOKDING  TO  ACT  OF  CONGRESS 
IN  THE  YEAR    MDCCCXCIV,  BY 

EUGENE    S.   TALBOT, 

IN  THE  OFFICE  OF  THE  LIBKABIAN  OF  CONGRESS 
AT  WASHINGTON,  D.  C. 


PRESS  OF 
ROGER  SON    &    C0  3IPANY 

184-186   MONROE   STREET 

CHICAGO 


TO  THE 

FELLOWS  OF  THE  CHICAGO  ACADEMY  OF  MEDICINE 

WHOSE   PHILOSOPHICAL    CKITISCISMS   AND 

MEDICAL  ACUMEN  HAYE  SUSTAINED  THE  AUTHOR  DURING  THE 

TEDIOUS   PROCESS   OF   STATISTICAL  INQTJiaY 

THIS  YOLUME  IS  RESPECTULLY  DEDICATED 


PREFACE 

The  earlier  editions  of  the  present  work  were  an  out- 
growth of  researches  which  tended  to  oppose  the  too  prev- 
valent  theory  (erroneous  in  its  deductions  and  vicious  in 
its  effects  on  practice)  that  irregularities  of  the  teeth  and 
jaws  were  the  result  of  local,  not  constitutional  conditions. 
The  increasing  volume  of  evidence  against  this  theory 
has  forced  the  author  to  extend  the  scope  of  his  original 
inquiry  into  departments  of  oral  and  nasal  medicine,  and 
surgery  of  the  eye,  ear  and  face,  so  intimately  related  to 
dental  medicine  through  the  causation  originally  assigned 
for  irregularities  of  the  teeth  and  jaws.  The  alleged 
causative  factors  in  the  case  of  the  nose  and  mouth  were 
themselves  often  found  to  be  of  constitutional  origin. 
The  scope  of  the  researches  presented  in  this  edition, 
therefore,  while  seemingly  extended,  are  practically  con- 
fined   to   the   limits  of  the  original  inquiry. 

The  author  desires  to  acknowledge  his  indebtedness  to 
Drs.  J,  G.  Kiernan,  Richard  Dewey,  H.  M.  Bannister  and 
James  A.  Lydston  for  valuable  suggestions.  Illustra- 
tions, Figs.  77,  78,  79,  80,  81,  82,  89,  90  and  91,  are 
taken  from  the  work  of  Zuckerkandl  as  reproduced  by 
Bosworth   (Diseases   of  the   Nose   and  Throat). 

EUGENE  S.  TALBOT. 

125  State  Steeet.  Chicago,  March  1894. 


TABLE   OF    CONTENTS 

CHAPTER  I. 

PAGE 

Historical   Sketch   of   Theories    Regarding    the 
Etiology  of  Irregularities  of  the  Maxillae 

AND  Teeth 1 

Supernumerary  Teeth 1 

Thumb-sucking  and  Similar  Causes 2 

Retention  of  Temporary  Teeth 4 

Growth  of  Maxilla 6 

Sleeping  with  The  Mouth  Open C 

Premature  Extraction  of  Temporary  Teeth     .  6 

Development  of  Sphenoid 9 

Attributed  to  Civilization 9 

Constitutional  Causes 11 

Want  of  Proportion  Between  Jaws  and  Teeth  14 

CHAPTER  n. 

Changes  in  Climate 18 

CHAPTER  III. 

Intermixture  of  Races 26 

CHAPTER  IV. 

Hereditary  Influence 38 

CHAPTER   V. 

Development  of  the  Cranium  and  Face      ....  45 

CHAPTER  VI. 

Development  of  the  Jaws 55 

Examination  of  the  Crania 58 

Mouths  of  Living  Persons — Lateral  Diameter  66 

Antero-Posterior  Diameter 69 

Height  of  Vault 71 


X  TABLE    OF    CONTENTS 

CHAPTER   VII. 

PAGE 

Development  of  the  Vault 84 

Normal  Vault 92 

By  What  Standard   Shall    we  Measure   the 

Vault 94 

CHAPTER  VIII. 

Development  of  the  Alveolar  Process    ....       97 

The  Inferior  Alveolar  Process 99 

Hypertrophy  of  the  Alveolar  Process    .     .     .     108 

CHAPTER  IX. 

Developmental  Neuroses 112 

CHAPTER  X. 

Crime 119 

Deformities  of  the  Jaw  as  Seen  in  Criminals   .     159 

CHAPTER  XI. 

Prostitution  and  Sexual  Degeneracy 161 

Sexual  Degeneracy 171 

CHAPTER  XII. 

Moral  Insanity,  Pauperism  and  Inebriety    .     .     .     172 
Inebriety 174 

CHAPTER  XIII. 

Intellectual  Degeneracy 175 

Maxillary  Deformities  among   the  Insane     .     178 

CHAPTER  XIV. 

Neurotics 181 

Neurotic  Cases 186 

CHAPTER  XV. 
Genius 189 


TABLE    OF    CONTENTS  XI 

CHAPTER  XVI. 

FAOE 

Idiocy 194 

Abnormai-ly  Shaped  Heads 202 

CHAPTER  XVII. 

Nutritive,  Degenerative,  Spinal  and  Local  Rever- 

sional  Tendencies 207 

CHAPTER  XVIII. 
Consanguinity  of  Parents .     209 

CHAPTER  XIX. 
Intemperance 214 

CHAPTER   XX. 

Maternal  Impressions      ,     .     .     .     .     .     .     .     .     .     218 

CHAPTER  XXI. 

City  versus  Country  Life 221 

CHAPTER    XXII. 

Constitutional  Lesions 227 

CHAPTER   XXIII. 

Neuroses  of  Development  of  the  Bones  of  the 

Head  and  Face 231 

CHAPTER  XXIV. 

Neuroses  and  Compensatory  Development  of  the 

Bones  of  the  Nose 251 

CHAPTER  XXV. 

Neuroses  of  Development  of  the  Antrum    .     .     .     281 


Xll  TABLE    OF    CONTENTS 

CHAPTEK  XXVI. 

PA(iE 

Neuroses  of   Development  of  the  Bones  of  the 

Orbits 294 

Ocular   Affections  Ascribable  to  Deformity 
OF  THE  Orbits 296 

CPIAPTER  XXVII. 

Neuroses  of  Development  of  the  Bones  of  the  Ear     800 

CHAPTER  XXVIII. 

Neuroses  of  Development  of  the  Jaws  of  Appar- 
ently Normal  Individuals 302 

CHAPTER  XXIX. 

Neuroses  of  Development  of  the  Maxillary  Bones  304 

De^'elopment  of  Inferior  Maxilla  by  Exercise  306 
Asymmetry    of    the   Lateral   Halves  of  the 

Maxillary  Bones 308 

Asymmetry  of  the  Maxillary  Bones  .     .     .     .  313 

Asymmetry  of  the  Rami 315 

Asymmetry  in  the  Body,  and  Improper  Occlu- 
sion    316 

Imperfect  Occlusion 320 

Protrusion  of  the  Inferior  Maxilla   .     .     .     .  321 

CHAPTER    XXX. 

Neuroses  of  Development  of  the  Vault    ....  327 
Thumb-sucking  and  Similar  Causes  Producing 

High  Vaults 328 

Fallacies  of  Clouston's  Theories 330 

The  Vault  in  its  Relation  to  Temperaments    .  334 
Shape  of  the  Vault  Compared  with  the  Shape 

*           OF  the  Head 340 

Mouth-breathing    Not    the    Cause    of    Con- 
tracted Jaws  and  High  Vaults  .....  349 
Development  of  the  Vault 379 


TABLE    OF    CONTENTS  Xlll 

CHAPTER  XXX— CONTINUED. 

pa(;e 

Deformity  of  the  Suture 385 

Deformed  Vaults 393 

Deformed  Vaults  Due  to  Local  Irregulari- 
ties OF  the  Teeth   .     .     . 394 

CHAPTER  XXXI. 
Cleft  Palate 396 

CHAPTER  XXXII. 

Neuroses  of  Development  of  Irregularities  of  the 

Teeth .  401 

The  V-shaped  Arch 401 

The  Normal  Arch 402 

Formation  of  the  V-shaped  Arch      ....  403 
Description    of  the  V-shaped    Arch  and  its 

Modifications 408 

Irregularities  of  the  Lower  Jaw 415 

The  Saddle-shaped  Arch 419 

Description  of  the   Saddle-shaped  Arch  and 

its  Modifications 424 

.     Combination  of  V  and  Saddle-shaped  Arches   .  426 

The  Saddle-shaped  Arch  of  the  Lower  Teeth  430 

CHAPTER  XXXIII. 

Local  Causes  of  Irregularities  of  the  Teeth — 

Upper  Jaw 431 

The  Central  Incisor  —  Irregularities  Pro- 
duced BY  THE  Malposition  of  Central  Inci- 
sors Resulting  from  Flexion  of  the  Alveo- 
lar Process 432 

Irregularities  Produced  by  the  Malposition 
OF  Central  Incisors — Due  to  Vicious  Erup- 
tion   436 

Irregularities  Produced  by  the  Malposition 
OF  Laterals 437 


Xiv  TABLE    OF    CONTENTS 

CHAPTER  XXXIII— CONTINUED. 

PAGE 

Irregularities  Produced  by  the  Malposition 
OF  the  Cuspids 441 

Irregularities  Produced  by  the  Malposition 
OF  the  Bicuspids 445 

Irregularities  of  the  Teeth  Produced  by  the 
Extraction  of  the  First  Permanent  Molar   .     448 

CHAPTER  XXXIV. 

Local  Causes   of  Irregularities  of  the   Teeth — 

Lower  Jaw 454 

The  Inferior  Cuspid 458 

Low^ER  Bicuspids 460 

Migration  of  Teeth 461 

The     Movement     of     Individual    Teeth     in 

Straight  Lines 463 

Rotation  of  Individual  Teeth  upon  their  Axes  465 
The  Forward  Movement  of  Groups  of  Teeth 

AND  THE  Alveolar  Process  Supporting  Them  465 
Anterior    Protrusions    from    Constitutional 

AND  Local  Causes 465 

CHAPTER  XXXV. 
Supernumerary  Teeth 469 

CHAPTER  XXXVI. 
Missing  Teeth .     .     474 

CHAPTER  XXXVII. 

Thumb  and  Finger  Sucking 476 

CHAPTER   XXXVIII. 
Conclusions .    480 

CHAPTER  XXXIX. 
Explanation  of  Plates     ..........     485 


INTRODUCTION. 

The  causation  of  deformities  of  the  head,  face,  jaws  and 
teeth  has  not  received  the  attention  from  scientists  which 
its  importance  demands.  Of  late  these  deformities  have 
been  traced  to  climatic  changes,  race  intermixture,  heredity 
and  social  environment.  The  unstable  conditions  of  this  last, 
as  shown  in  commercial  civilization,  give  rise  to  a  tendency 
to  the  development  of  these  conditions.  The  teeth,  jaws 
and  face  have  been  variable  factors  in  evolution,  and  hence 
are  most  readily  affected  by  the  forces  tending  to  degen- 
eracy. Such  conditions  are  easily  affected  by  the  factors 
arising  out  of  the  "struggle  for  existence." 

The  law  of  the  "survival  of  the  fittest"  affects  not 
only  the  entire  organism,  but  also  the  parts  themselves. 
Some  one  part  attains  imdue  development.  Such  a  product 
of  degeneracy  once  obtained  might,  under  proper  conditions, 
remain,  while  the  rest  of  the  body  returned  to  the  normal 
type.  The  frequency  with  which  these  stigmata  of  degen- 
eracy are  found  in  otherwise  sound  systems  indicates  that 
the  law  of  atavism  tends  to  eradicate  as  well  as  to  cause  them. 
Given  these  deformities  in  a  subject  of  normal  mental 
health,  they  simply  indicate  that  a  more  or  less  remote 
ancestor  had  been  subject  to  the  influence  of  the  factors 
producing  degeneracy,  but  that  in  the  main  the  offspring 
were  regaining  the  normal  standard. 

The  lesson  to  be  drawn  from  these  stigmata  is  the 
hygienic  one  that,  given  the  tendency  to  degeneracy  shown 


XVI  INTRODUCTION 

in  these  deformities,  the  progress  of  that  person  under  the 
factors  named  will  tend  more  toward  disease  than  that  of 
the  person  in  whom  they  are  absent.  The  frequency  of 
these  deformities  should  hence  have  early  created  the  sus- 
picion that  they  were  of  constitutional  and  not  local  origin, 
and  should  have  once  more  taught  the  old,  old  lesson  in 
medicine:  that  a  knowledge  of  a  man's  ancestry  is  of  great 
value  in  treatment. 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES 


OF  THE 


HEAD,  FACE,  JAWS  AND  TEETH. 


CHAPTER  I. 

HISTORICAL  SKETCH  OF  THEORIES  REGARDING 

THE  ETIOLOGY  OF   IRREGULARITIES  OF 

THE   MAXILLA  AND  TEETH. 

SUPERNUMERAEY   TEETH. 

Hippocrates,  who  lived  about  500  b.  c.  ,  was  the  first  to 
study  human  teeth,  and  laid  down  the  dictum,  "  The  more 
teeth  the  longer  life."  "  The  fewer  teeth  the  shorter  life," 
said  Aristotle  about  one  hundred  years  later. 

In  1618  Hilkiah  Crooke  published  a  work,  Mixpoxoa fj-oy- 
pacpia^  in  which  he  gives  the  views  of  the  best  anatomists 
of  his  day.  In  this  it  is  observed  that  there  are  sometimes 
four  and  sometimes  five  grinders. 

On  Second  Dentition  the  author  says:  "The  shearing 
{i.  e. ,  incisors)  teeth,  when  they  do  break  forth,  do  thrust  the 
first  shearers  out  before  them  and  issue  betwixt  the  first  two, 
the  second  and  the  dog  tooth  that  is  next  unto  them.     But  if 


2  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

the  former  teeth  will  not  fall  or  be  not  pulled  out,  or  if  the 
latter  issue  before  the  tirst  fall,  then  the  latter  make  their 
way  through  new  sockets,  and  turn  in  the  upper  jaw  outward, 
in  the  lower  jaw  inward,  so  that  there  seemed  to  arise  a  new 
row  of  teeth,  and  this  indeed  hath  deceived  many  historians 
and  anatomists  also." 

Barth  Ruspini,  in  1750,  says  :  "  All  the  teeth  that  exceed 
thirty-two  may  be  regarded  as  supernumerary."  He  attrib- 
utes irregularity  of  canines  and  incisors  to  extreme  narrow- 
ness of  the  jaws. 

Robert  Blake,  in  a  translation  of  his  inaugural  Disserta- 
tion, published  in  1798,  speaks  of  supernumerary  and  inverted 
teeth. 

Joseph  Harris,  "  A  Familiar  Treatise  on  the  Teeth,"  1830: 
"  Irregularity  is  due  to  supernumerary  teeth." 

John  Winckworth,  1831,  speaks  of  supernumerary  teeth 
causing  irregularity. 

THUMB-SUCKING,   AND  SIMILAR  CAUSES. 

}/'  J.  Imrie,  Parenfs  Dental  Guide,  1834:  "Irregularity 
is  due  to  want  of  development  of  jaw-bones,  intemperance  of 
various  kinds  combined  with  artificial  modes  of  living  intro- 
duced by  civilization,  and  sudden  transition  from  heat  to  cold 
to  which  the  teeth  are  subject — all  these  have  a  tendency  to 
prevent  development  of  the  bones.  Rabbit  mouth  is  due  to 
keeping  the  thumb  in  the  mouth  for  hours,  after  going  to 
sleep.  Underhung  jaw  is  due  to  'sucking  the  tongue,' by 
throwing  the  under  jaw-bone  from  its  articulation.  A  simi- 
lar state  of  the  teeth  and  jaw-bones  is  induced  when  attempts 
are  made  by  the  inexperienced  to  regulate  them  by  the 
extraction  of  teeth  in  the  upper  jaw  and  neglecting  to  remove 
an  equal  number  of  the  lower." 

*/  J.  Lefoulon,  "A  new  Treatise  of  Theory  and  Practice  of 
Dental  Surgery"  (translated  from  the  French  by  Thomas 
Bond,  1844):  "Among  the  causes  of  Dental  Irregularity  we 
may  regard  as  the  most  frequent  the  neglect  of  proper  super- 
vision of  second  dentition.  Very  often  the  temporary  teeth 
are  too  precipitately  removed,  and  again  the  opposite  error  is 


THE    HEAD,    FACE,    JAWS    AND    TEETH  3 

committed  of  suffering  them  to  remain  even  after  the  per- 
manent have  partly  appeared.  There  results  from  this  an 
error  of  relation  between  the  development  of  the  palatine 
arch  and  the  superior  alveolar  border,  or  of  the  two  arches  at 
once,  relatively  to  the  size  of  the  teeth.  Another  cause  is  the 
bad  habit  of  permitting  children  to  suck  their  thumbs  and 
continually  to  be  putting  their  hands  into  their  mouths. 
Another  cause  is  the  frequently  repeated  action  of  the  tongue 
in  the  pronunciation  of  certain  syllables  called  lingual,  in 
which  that  organ,  striking  against  the  anterior  superior  teeth, 
gives  rise  to  anterior  obliquity  of  the  superior  arch.  We 
may  remark  that  this  deformity  is  very  frequent  with  the 
English,  resulting  from  the  pronunciation  of  lingual  sylla- 
bles." 

About  the  same  year  Dr.  Thos.  Ballard  claimed  certain 
peculiarities,  such  as  serrated  teeth  and  projecting  jaws,  to 
be  the  result  of  fruitless  sucking. 

Stockton's  Dental  Intelligencer^  1845,  from  the  ' '  Forceps :"  |^/^ 
"The  comparative  ease  by  which,  with  pressure,  the  incisors 
or  bicuspids  may  be  made  to  alter  their  position,  would 
naturally  suggest  the  idea  that  the  tongue,  lips  or  cheek 
might,  in  some  measure,  influence  their  original  direction; 
but  as  these  are  pressed  by  every  one,  while  certain  individ- 
uals only  have  their  teeth  unevenly  arranged,  we  may  look 
for  some  other  accessory;  and  this  may  be  found  in  the  form 
of  the  palate,  certain  peculiarities  of  which  are  found  in  con- 
nection with  similar  forms  of  the  dental  arch.  Irregularity 
of  position  is  almost  exclusively  confined  to  anterior  five 
teeth  on  each  side  of  the  medial  line,  brought  about  by  pres- 
sure of  tongue  upon  hard  palate  in  sucking  or  mastication." 

Nasmyth's  ' '  Researches  on  Development,  Structure  and 
Diseases  of  the  Teeth,"  1845:  "Projecting  upper  jaw  is  >^ 
often  the  result  of  a  habit  of  sucking  the  tongue  or  finger  in 
infancy.  But  both  projecting  upper  and  projecting  lower 
jaw  arise  from  an  arrest  of  development  in  the  jaw  when 
expansion  of  the  arch  is  deficient."  He  also  states  that  we 
find  the  prominent  mouth  in  uncivilized  races. 

The  theory  that  irregularity  may  be  due  to  thumb-suck- 


4  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

ing,  so  much  made  of  in  modern  times,  was  mentioned  by 
different  writers  during  the  last  forty  years.  Among  these 
H.  D.  Ross  speaks  of  it  in  1853.  At  the  same  time  he 
remarks,  what  must  have  been  observed  as  soon  as  there  was 
an  attempt  at  correction,  that  there  is  greater  diflSculty  in 
keeping  teeth  in  position  after  they  are  moved  than  in  mov- 
ing them. 
/  A.  A.  De  Lessert,  1873,  attributes  deformity  to  fruitless 
sucking  and  to  enlarged  tonsils,  which  necessitate  an  open 
mouth. 

Thomas  Salter,  "Dental  Surgery, "1874,  attributes  irregu- 
larity to  hypertrophy  of  tongue  and  thumb-sucking. 

J.  W.  White,  1879,  says  that  the  protrusion  of  lower  jaw 
is  due  to  the  habit  of  sucking  the  first  and  second  fingers;  the 
weight  of  the  hand  and  arm  causing  a  protrusion  of  lower 
jaw  and  teeth. 

Mr.  Francis  Fox,  "Irregularity  of  Teeth  and  their 
Surgical  Treatment,"  1880:  Causes  of  irregularity  are 
"want  of  proportion  in  the  size  of  the  teeth  and  jaw-bones 
or  prolonged  retention  of  temporary  teeth,  supernumerary 
teeth,  habit  of  thumb-sucking  or  undue  pressure  from  an 
hypertrophied  tongue,  or  heredity." 

RETENTION  OF  TEMPORARY  TEETH. 

Thomas  Berdmore,  in  1768,  says  that  the  cause  of  super- 
numerary teeth  or  a  double  row  of  teeth  is  due  to  the  fact 
that  the  milk-teeth  are  never  shed,  notwithstanding  the  fact 
that  the  permanent  teeth  appear.  Irregularity  of  teeth  is 
due  to  the  resistance  offered  the  permanent  by  the  temporary, 
which  also  occasions  snaggled,  rough  and  indented  teeth. 

Joseph  Fox,  "Natural  History  of  Human  Teeth,"  in 
1803:  "Most  frequent  cause  of  irregularity  is  a  want  of 
simultaneous  action  between  the  increase  of  the  permanent 
teeth  and  the  decrease  of  the  temporary  ones  by  the  absorp- 
tion of  their  fangs,  most  commonly  occasioned  by  the  resist- 
ance of  the  nearest  temporary  teeth;  also  from  the  fact  that 
the  permanent  teeth  are  too  large  for  the  space  occupied  by 
the  temporary.     The  growth  of  more  teeth  than  the  natural 


THE    HEAD,    FACE,    JAWS    AND   TEETE  5 

number  frequently  occurs,  and  is  always  the  cause  of  great 
irregularity  of  the  teeth." 

Joseph  Murphy,  in  "Natural  History  of  the  Human 
Teeth,"  speaks  of  irregularity  due  chiefly  to  the  first  teeth 
not  having  been  shed  in  time, 

Benjamin  James,  in  "A  Treatise  on  the  Management  of 
the  Teeth,"  1814,  saysi:  "With  proper  attention  paid  to  the 
removal  of  the  first  set  of  teeth,  the  regularity  of  the  second 
set  may  be  anticipated." 

Parmly,  in  "Lectures  on  Natural  History  and  Manage- 
ment of  the  Teeth,"  1830,  states  that:  "Want  of  attention 
during  the  period  of  shedding  the  first  set  of  teeth  is  great 
cause  why  irregularity  of  the  teeth,  and  consequent  deformity 
of  the  mouth,  are  apt  to  take  place."  "When  the  permanent 
teeth  are  large,  and  growth  of  the  jaw  does  not  proceed  in  a 
corresponding  proportion,  they  are  found  to  crowd  and  over- 
lap each  other." 

G.  Waite,  "Surgeon-Dentists'  Anatomical  and  Physio- 
logical Manual,"  1826:  "Irregularities  of  the  teeth  are 
mostly  occasioned  by  the  pressure  of  the  temporary  upon  the 
permanent,  throwing  them  in  a  wrong  direction." 

S.  S.  Fitch,  "  System  of  Dental  Surgery,"  1835;  "  Irregu- 
larity is  due  to  want  of  simultaneous  action  between  the 
increase  of  the  permanent  teeth  and  the  decrease  of  the 
temporary  by  the  absorption  of  their  fangs;  to  the  greater 
size  of  the  permanent  in  comparison  with  the  temporary." 

"Treatise  on  Diseases  of  the  Mouth,"  by  J.  B.  Garriot, 
1843,  translated  by  J.  B.  Savier:  "  Deciduous  teeth,  by  their 
presence,  often  prevent  the  permanent  teeth  from  arranging 
themselves  in  their  proper  position.  Should  we  neglect  to 
extract  the  milk-teeth  and  other  measures  capable  of  favoring 
a  good  arrangement  of  the  permanent  teeth,  deformity — often 
very  serious — may  ensue. 

GROWTH    or    MAXILLA. 

Hunter,  in  1771,  in  "Natural  History  of  the  Teeth," 
speaks  of  supernumerary  teeth;  he  states  that  the  jaw  grows 
at  theposterior  edges^  and  that  irregularity  is  often  due  to  the 


b  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

ten  anterior  permanent  teeth  being  larger  than  the  ten  anterior 
temporary  teeth,  while  the  corresponding  part  of  the  jaw  is 
of  the  same  size;  therefore  in  such  cases  the  second  set  is 
obliged  to  stand  very  irregularly." 

G.  M.  Humphrey  made  observations  on  the  mode  of 
growth  of  the  lower  jaw.  He  claims  there  is  no  interstitial 
growth.  The  five  permanent  front  teeth  occupy  exactly  the 
same  position  throughout  life,  and  all  other  additional  teeth 
are  added  to  the  hinder  end  of  the  jaw.  This  hind  end  is 
enlarged  by  the  absorption  of  the  anterior  coronoid  edge  and 
the  deposition  on  the  posterior  edge.  When  the  molars  are 
first  formed  they  are  under  the  coronoid  process,  and  are 
subsequently  exposed — theories  proven  by  experiments  on 
young  pigs. 

SLEEPING   WITH    THE    MOUTH    OPEN. 

^  Tomes,  in  "Dental  Surgery,"  1859  and  1870,  mentions 
the  fact  that  deformity  is  caused  by  sleeping  with  the  mouth 
open.     He  makes  no  mention  of  this  in  edition  of  1848. 

W.  Matthews,  1880,  in  paper  read  before  Students' 
Society  of  the  Dental  Hospital  of  London,  attributes  irregu- 
larity to  enlarged  tonsils,  which  necessitate  breathing  being 
carried  on  with  open  mouth;  also  to  heredity,  maxillae  being 
smaller  in  proportion  than  the  teeth,  which  is  due  to  the 
lessened  work  of  maxillae  and  teeth  by  civilized  races ;  also 
cross-breeding  and  thumb  and  lip-sucking,  retarded  shedding 
of  temporary  teeth,  and  too  early  extraction  of  first  permanent 
molars,  "Congenital  V-shaped  jaw  is  that  form  in  which, 
previous  to  birth,  the  form  of  the  upper  maxillae  is  such  that 
its  cornua  do  not  diverge  posteriorly,  but  are  parallel,  and  as 
that  portion  of  the  jaw  already  formed  never  changes  its 
form,  the  newly-added  parts  will  pass  off  in  divergent  lines, 
forming  an  angle  with  that  previously  existing,  in  order  to 
correspond  with  the  increasing  width  of  the  base  of  the  skull." 

PREMATURE  EXTRACTION  OF  TEMPORARY  TEETH. 

L.  Koecker,  1826:  "The  deformity  which  consists  in 
shutting  the  under  incisors  and  cuspidati  over  the  upper,  has 


THE  HEAD,  FACE,  JAWS  AND  TEETH  T 

been  produced  by  the  injudicious  extraction  of  some  of  the 
teeth  of  the  upper  jaw,  without  taking  proper  care  to  secure 
a  due  proportion  between  the  upper  and  under  jaws."  We 
have  irregularity  also  when  the  temporary  teeth  are  not 
extracted  in  time,  and  when  we  have  too  long  persistence  of 
temporal  y. 

Thomas  Bell,  "  Anatomy,  Physiology  and  Diseases  of  the 
Teeth,"  1829:  "Most  unusual  cause  of  permanent  irregu- 
larity is  the  actual  want  of  sufficient  room  in  the  jaw  of  the 
ultimate  regular  arrangement  of  the  teeth,  and  this  may  occur 
from  disproportionate  narrowness  of  the  jaw  (whether  from 
original  formation  or  produced  by  too  early  removal  of 
temporary  teeth)  or  from  preternatural  size  of  the  permanent 
teeth." 

Joseph  Scott,  "Art  of  Preventing  Loss  of  Teeth,"  1831: 
"  Irregularities  arise  from — first,  a  natural  want  of  sufficient 
expansion  in  the  jaw  bone  at  the  time  of  their  protrusion; 
second,  from  not  extracting  the  temporary  teeth  at  the  proper 
time;  third,  by  too  early  an  extraction  of  the  temporary 
teeth;  fourth,  from  supernumerary  teeth." 

John  NichoUes,  "Teeth  in  Kelation  to  Beauty,  Voice  and 
Health,"  1833:  "Deformity  may  be  due  to  too  long  persist- 
ence of  temporary  teeth,  or  may  arise  from  some  malforma- 
tion of  the  teeth  or  jaw,  entirely  beyond  the  previous  control 
of  the  dentist." 

K.  Maclean,  "  Treatise  on  Human  Teeth,"  1836:  "Due 
expansion  of  the  jaw  is  prevented  by  premature  extraction  of 
the  temporary  teeth;  the  permanent  thereby  becoming 
crowded  and  irregular." 

E.  Spooner,  "Popular  Treatise  on  the  Teeth,"  1836: 
' '  First,  and  most  frequent  cause  of  irregularity,  is  a  want  of 
simultaneous  action  between  the  protrusion  of  the  permanent 
teeth  and  absorption  of  the  fangs  of  the  temporary.  Second 
cause  is  a  narrowness  of  the  maxillary  arch  or  a  want  of 
proportion  between  the  extent  of  it  and  the  size  of  the  teeth. 
Another  cause  is  by  the  premature  extraction  of  the  tempo- 
rary teeth;  the  jaw  is  liable  to  contraction,  and  when  the 
permanent  teeth  come  in  there  will  not  be  room  in  the  jaw 


8  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

for  them.     Irregularity  is  also  due  to  supernumerary  teeth." 

Wm.  Thornton,  "A  Popular  Treatise  on  the  Preservation 
of  Teeth  and  Gums,"  1836:  "  Irregularities  of  the  teeth  pro- 
ceed from  three  causes, — first,  from  a  natural  want  of  suffi- 
cient expansion  in  the  jaw-bones  at  the  time  of  the  protrusion 
of  the  teeth;  second,  not  extracting  the  temporary  teeth  at 
the  proper  time;  third,  too  early  an  extraction  of  the  tempo- 
rary teeth." 

Mortimer,  1830:  "Irregularities  arise  from  natural  or 
accidental  causes. 

^'■Natural  causes  arise  from  a  bad  conformation  of  the  jaw, 
so  that  several  teeth  are  over  each  other;  from  the  teeth  being 
much  larger  than  they  should  be;  from  coming  out  of  order 
and  place;  from  teeth  growing  out  of  the  palate  or  projecting 
into  the  mouth. 

'■''Accidental  causes  arise  from  neglect  or  ignorance  in 
removing  milk-teeth  too  soon;  when  the  second  teeth  from 
some  internal  cause  take  a  direction  inwards  or  outwards; 
underhung  jaw  arises  from  making  faces." 

Charles  De  Loude,  "Surgical,  Operative  and  Mechanical 
Dentistry,"  1840:  "Irregularity  is  due  to  supernumerary 
teeth,  to  second  teeth  being  too  large  and  maxillary  arch  too 
narrow,  and  to  too  early  extraction  and  too  long  persistence 
of  temporary  teeth,  and  to  shape  of  the  maxillary  arch,  and 
to  heredity,  where  the  child  inherits  the  jaw  of  one  parent 
and  the  teeth  of  the  other." 

Sam  Ghimes,  1843,  speaks  of  the  underhung  jaw  being 
due  to  the  upper  incisors  extending  inwards,  and  on  closing 
the  mouth  they  come  in  contact  with  the  lower;  this  makes 
the  child  inclined  to  protrude  the  lower  jaw,  which  finally 
becomes  habitual,  and  promotes  the  increase  in  the  length  of 
the  jaw  itself. 

Early  French  writings  contain  little  or  nothing  on  the 
subject.  In  a  German  work — "NesseFs  Compendium  der 
Zahnheilkunde,"  1856 — the  cause  of  irregularity  is  attributed 
to  the  premature  extractions  of  temporary  teeth.  The  alveoli, 
it  is  stated,  foj-m  a  bonescar  in  such  cases,  which  is  an  obstacle 
to  the  advancement  of  the  permanent  teeth.    In  consequence, 


THE    HEAD,    FACE,    JAWS    AND    TEETH  9 

It  is  claimed,  the  permanent  teetii  come  before  the  jaw  is  suf- 
ficiently expanded  to  receive  them. 

DEVELOl'MENT   OF   SPHENOID. 

J.  L.  Down,  "Relation  of  Teeth  and  Mouth  to  Mental 
Development,"  1871,  wrote:  "Excessive  vaulting  of  palate, 
due  to  arrest  of  development  of  the  sphenoid  or  defective 
growth  of  vomer.  The  defects  are  developmental  defects, 
and  betoken  a  cause  long  anterior  to  the  time  when  sucking 
the  thumb  is  practiced,  unless  that  habit  be  an  intra-uterine 
one." 

Mr.  Oakley  Coles,  "Origin  and  Treatment  of  Certain 
Irregularities  of  the  Teeth,"  1881,  before  International  Medi- 
cal Congress,  said  his  observations  in  regard  to  intermaxil- 
lary prognathism  were  based  on  the  authority  of  Mr.  Hilton. 

Dr.  Oakley  Coles  expressed  the  opinion,  held  by  others 
about  the  same  time,  that  the  best  types  of  English  jaw  give 
an  equilateral  triangle.  He  applied  Greek  names  to  the  dif- 
ferent classes  into  which  he  divided  various  forms  of  arches; 
he  gave  no  basis  for  his  classification  except  that  of  form.  He 
attributed  intermaxillary  prognathism  to  a  force  originating 
in  the  sphenoid  bones  and  acting  on  the  intermaxillary  bone, 
and  held  that  premature  ossification  of  the  sutures  operates 
powerfully  in  the  production  of  oral  deformity. 

ATTRIBUTED   TO    CIVILIZATION. 

J.  P.  Clark,  "A  New  System  of  Treating  Human  Teeth," 
1829:  "  Irregularity  may  arise  from  too  premature  extrac- 
tion of  temporary  teeth.  Disproportion  between  the  teeth 
and  the  jaws,  may  be  occasioned  by  a  natural  conformation  of 
the  parts,  or  may  be  the  unnoticed  effect  of  accident.  For  we 
seldom  find  any  such  disproportion  and  consequent  irregular- 
ity in  the  teeth  of  men  and  animals  in  a  wild  state. ' ' 

J.  L.  Levison,  in  "Jaws  and  Teeth  of  Semi-barbarous 
Men,"  1852:  "The  jaws  of  civilized  men  are  more  con- 
tracted than  those  of  semi-barbarous  races,  and  this  is  the 
result  of  the  direct  violation  of  the  Creator's  laws,  who  willed 
that  the  brain  and  nervous  system  of  the  growing  child  should 


10  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

not  be  overtaxed,  and  that  the  dental  process  of  attempting 
to  build  up  the  organic  instruments  and  cultivate  the  mental 
faculties  at  the  same  time  is  a  matter  almost  impossible  to 
accomplish." 

In  British  Journal  of  Dental  Science  of  1864  an  extract 
of  George  Catlin's  '' Breath  of  Life  "  is  given.  In  this  he 
states  that  malformations  of  teeth  are  due  to  keeping  the 
mouth  open,  as  civilized  man  is  the  only  animal  who  keeps 
his  mouth  open  during  sleep. 

Mr.  Mummery  and  Mr.  Nichols  made  extensive  observa- 
tions in  1860  on  the  teeth  of  savage  races.  They  report  that 
irregularities  of  the  teeth  and  contracted  jaws  were  rare.  Mr. 
Nichols  found  but  one  case  of  slight  irregularity  among  the 
thousands  of  Indians  and  Chinese  which  he  examined.  Messrs. 
Coleman  and  Cartwright  examined  a  large  number  of  skulls 
in  the  crypt  of  Hythe  Church  in  Kent.  These  were  very  old, 
though  their  history  is  not  known  definitely.  All  of  them 
had  well-developed  jaws  and  alveolar  arches,  and  the  teeth 
that  were  still  present  were  remarkably  regular. 

About  1864  Mr.  Samuel  Cartwright  read  an  able  paper 
before  the  Odontological  Society  of  Great  Britain.  In  this 
he  expresses  his  views  that  irregularities  result  from  selective 
breeding;  that  they  are  both  congenital  and  hereditary;  that 
there  is  very  little  increase  in  the  anterior  part  of  the  jaw 
after  eight  or  ten  years;  that  if  the  temporary  teeth  were  to 
remain  the  jaws  would  not  change  from  those  of  childhood; 
that  in  all  cases  of  irregularity  the  maxillae  are  more  or  less 
altered  in  proportion  of  development,  whilst  the  teeth  main- 
tain, in  regard  to  their  size,  an  average  development. 

Mr.  Hepburn,  in  "Irregularities  of  Teeth  and  Their 
Treatment, "  1870,  says:  "Contracted  maxill8e  and  alveoli 
are  the  result  of  artificial  life  and  other  causes  attendant  on 
civilization.  Ethnologists  affirm  that  with  the  advance  of 
civilization,  there  is  decrease  in  the  size  of  the  facial  and 
maxillary  bones."  Deformity  is  also  attributed  to  cross- 
breeding. 

Among  comparatively  recent  works  on  irregularities,  that 
by  Kingsley  on  "Oral  Deformities  "  is  one  of  the  most  im- 


THE    HEAD,    FACE,    JAWS    AND   TEETH  11 

portant.  He  attributes  irregularities  chiefly  to  premature 
extraction  of  temporary  teeth,  intermarriage  between  persons 
of  different  nationalities,  hereditary  or  disturbed  innervation. 

CONSTITUTIONAL   CAUSES.* 

John  Fuller,  1810,  attributes  irregularity  to  too  long  per- 
sistence of  temporary  teeth;  he  also  says  that  the  upper  jaw 
is  too  small  for  the  permanent  teeth,  which  fact  often  occa- 
sions irregularity.  "  Some  children  have  the  habit  of  project- 
ing the  under  jaw  forward,  and,  of  course,  shutting  one  or 
more  of  the  under  front  teeth  beyond  the  upper,  which  soon 
becomes  permanent." 

Mr.  Sigmond,  in  "Treatise  on  Disease  and  Irregularities 
of  the  Teeth  and  Gums,"  1825,  attributes  irregularities  to — 
1,  natural;  2,  accidental  causes.  "Natural,  (1)  when  they 
result  from  the  jaw  not  expanding  sufficiently  to  allow  the 
teeth  to  form  a  regular  circle;  (2)  when  they  are  larger  than 
the  ordinary  dimensions;  (3)  when  they  do  not  appear  in 
their  proper  order  and  place.  Accidental,  when  caused  by 
negligence  or  improper  treatment  at  the  time  of  their  growth." 

Andrew  Clark,  "Practical  Directions  for  Preserving  the 
Teeth,"  1825:  "That  irregularity  of  the  teeth  is  occasioned 
by  want  of  room  in  the  jaw,  and  not  from  any  effect  that  the 
first  set  produce  upon  them,  is  evident  because,  in  all  cases 
of  irregularity,  we  find  that  really  there  is  not  room  to  admit 
of  placing  all  the  teeth  properly." 

William  Robertson,  "A  Practical  Treatise  on  the  Human 
Teeth,"  1841,  says:  "Deformity  is  due  to  inheriting  the 
contracted  jaw  of  one  parent  and  the  large  teeth  of  the  other." 

Savier's  translation  of  F.  Maury's  "Dental  Art"  1842: 
"Prominence  of  upper  jaw  is  due  to  narrowness  of  the  arch; 
recession,  due  to  the  anterior  teeth." 

C.  A.  Harris,  "Principles  and  Practice  of  Dental  Sur- 
gery," 1845:     "An  infringement  of  laws  of  growth  or  dis- 

*The  terms  "attributed  to  civilization"  and  "constitutional  causes  "  are 
used  by  the  author  in  order  to  harmonize  the  views  held  by  the  early  writers 
and  those  of  the  author.  By  this  arrangement  the  student  can  comprehend  the 
actual  causes  more  readily.  The  terms  used  by  the  author  are  explained  in 
chapter  XXXI. 


12  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

turbance  of  the  functional  operation  of  any  of  the  organs  of 
the  face  or  head  may  determine  an  improper  development  of 
the  jaw  and  a  bad  arrangement  of  the  teeth."  He  also  men- 
tions supernumerary  teeth  and  irregular  individual  teeth;  he 
attributes  irregularity  of  the  teeth  to  the  narrowness  of  the 
maxillary  arch,  and  sometimes  to  the  presence  of  temporary 
teeth. 

Arthur,  "A  Popular  Treatise  on  Diseases  of  the  Teeth," 
1845:  ''Irregularities  of  the  teeth  may  proceed,  amongst 
others,  from  three  principal  causes:  First,  the  presence  of  a 
greater  number  of  teeth  in  the  mouth  than  is  natural;  second, 
a  deficiency  of  space  in  the  jaw;  third,  a  wrong  direction  given 
to  one  or  more  at  the  time  they  make  their  appearance.  A 
deficiency  of  space  may  arise  from  a  contraction  of  the  jaws 
in  consequence  of  the  too  early  extraction  of  the  temporary 
teeth;  from  some  original  malformation  of  the  jaw,  or  from 
a  great  excess  in  size  of  the  second  set  over  the  first." 

W.  K.  Brideman,  1845,  "On  Causes  of  Irregularity  of  the 
Teeth,"  denies  the  aid  of  the  tongue,  lips  or  cheek  in  in- 
fluencing the  teeth  from  original  direction;  but  attributes  it 
to  shape  of  the  jaw. 

Sam  Harbert,  1847:  Irregularities  of  teeth  are  due  to 
premature  extraction  of  deciduous  teeth  and  protrusion  of 
permanent  before  the  absorption  of  a  deciduous  fang.  A 
projection  of  lower  jaw  is  attributable  to  neglect  in  second 
dentition;  generally  it  is  supposed  to  be  due  to  elongation  of 
the  jaw,  which  is  almost  always  an  error.  When  the  dental 
arch  becomes  contracted  at  the  medial  line,  giving  to  the 
mouth  a  pointed  appearance,  it  is  often  the  result  of  prema- 
ture extraction  of  certain  of  the  temporary  teeth.  "Practical 
Treatise  on  the  Operations  of  Surgical  and  Mechanical  Den- 
tistry." 

Alfred  Canton,  1851,  "Teeth  and  their  Preservation:" 
"Irregularity  of  teeth,  as  regards  their  shape,  position, 
direction,  crowded  condition,  etc.,  are  met  with  more  fre- 
quently than  IS  supposed  to  be  the  case.  Causes  are  chiefly 
mechanical,  depending  either  on  the  non-increase  in  size  of 
the  jaw  in  proportion  to  the  growth  of  the  teeth  to  be  con- 


THE    HEAD,    FACE,    JAWS    AND   TEETH  13 

tained  in  the  alveolar  arch;  on  the  position  of  the  permanent 
teeth  with  reference  to  the  fangs  of  their  predecessors,  and 
lastly,  on  the  increase  in  size  of  one  jaw  in  preference  to  the 
other." 

"Treatise  on  Second  Dentition,"  by  C.  F.  Delabarre,  trans- 
lated for  Ainerican  Journal  of  Dental  Science:  "  Malcon- 
formation  of  denture  may  be  occasioned,  first,  by  a  defect  in 
the  conformation  of  the  jaw;  second,  by  the  simple  want  of 
their  development  depending  upon  the  health  of  the  indi- 
vidual; third,  by  an  excess  in  the  development  of  all  the 
teeth,  though  the  jaws  are  in  other  respects  well  formed; 
fourth,  by  rapid  development  of  the  dentition  of  one  set  and 
delay  in  that  of  the  other;  fifth,  finally,  by  the  too  great  size 
of  the  teeth  of  one  jaw,  which  do  not  harmonize  with  those 
that  are  opposite."  "Some  forms  of  defective  palatine 
arches  are  hereditary." 

J.  K.  Duval,  "The  Youth's  Dentist:"  "In  a  projecting 
chin  the  alveolar  arch,  in  which  the  incisors  and  canines  are 
placed,  has  taken  a  development  upon  a  parabolic  line, 
greater  and  more  prominent  than  that  presented  by  the  body 
of  the  bone;  this  diflfers  very  little  from  a  similar  one  in 
upper  jaw,  which  projects  over  the  lower.  Upon  attention 
to  shedding  of  temporary  teeth  depends  the  fine  arrangement 
of  the  lower." 

Dr.  Gunnellj  in  American  Journal  of  Dental  Science^ 
states  that  protrusion  of  lower  jaw  is  in  many  cases  here- 
ditary; but  often  is  brought  about  in  this  way — the  incisors 
of  the  lower  jaw  are  cut  first,  and  when  the  upper  ones  make 
their  appearance  the  lower  have  nearly  arrived  at  their  full 
growth.  In  closing  the  mouth  they  come  in  contact  with  the 
gum  on  the  inside  of  the  upper  incisors,  and  for  relief  the 
lower  jaw  is  thrust  out,  which  soon  becomes  permanent." 

Samuel  Cartwright,  Jr.,  in  lecture  delivered  before  King's 
College,  reported  in  British  Journal  of  Dental  Scie7ice,  in 
June,  1857,  says,  the  "  irregularities  of  permanent  teeth  are 
due,  first,  to  non-absorption  of  the  roots  of  temporary  teeth 
in  proportion  to  the  rise  of  those  of  replacement;  second,  the 
great  difference  which  commonly  exists  in  the  size  of  the  new 


14  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

teeth  as  compared  with  those  of  the  first  set;  third,  contrac- 
tion of  the  arches  of  the  jaws  and  other  malformations  of 
maxillary  and  palate  bones,  originating  in  hereditary,  con- 
oenital  and  other  causes." 

A.  A.  Blount,  "Orthodontia,"  1866:  "Eemote  causes 
which  produce  irregularity  will  be  found  in  the  commingling 
of  all  nations,  with  national  and  individual  characteristics. 
Most  frequent  causes  are  the  result  of  accident,  indiscriminate 
extraction  of  the  deciduous  teeth  and  too  early  extraction  of 
permanent  teeth." 

H.  Sewell,  "Irregularities  and  Diseases  of  the  Teeth," 
1869:  "Protrusion  of  incisors  is  due  apparently  to  an 
abnormal  development  of  premaxillary  bone."  Irregularities 
are  due  to  "retention  of  temporary  teeth,  causing  permanent 
teeth  to  assume  an  unnatural  position,  also  to  malformation 
of  jaw,  which  are  usually  congenital  and  at  the  same  time 
hereditary;  may,  however,  be  due  to  injury  or  other  acci- 
dental causes." 

WANT  OF  PROPORTION  BETWEEN  JAWS  AND  TEETH. 

David  Jobson,  "On  the  Teeth,"  1834:  " Irregularity  is 
due  to  smallness  of  maxillary  arch  and  great  size  of 
permanent  teeth  and  their  situation,  part  on  inner  and  of 
others  on  outer  side  of  temporary  teeth." 

John  Mallan,  "Practical  Observations  on  Physiology  and 
Diseases  of  the  Teeth,"  1835:  "Now,  the  adult  teeth  being 
larger  as  well  as  more  numerous  than  the  milk-teeth,  it  is 
obvious  that  they  require  a  great  deal  more  room,  and  when 
the  absorption  of  the  latter  does  not  progress  equally  with 
the  growth  of  the  former,  the  new  teeth  are  crowded  up  and 
are  apt  to  be  forced  out  of  their  natural  position  by  the 
resistance  of  the  old.  Again,  if  the  permanent  prove,  as 
they  sometimes  do,  disproportionately  large  in  comparison 
with  their  predecessors,  the  jaw  may  not  be  sufficiently 
extended  to  admit  of  their  being  arranged  in  regular  order, 
in  which  case  some  overlap  the  others  and  considerable 
deformity  is  occasioned." 

Paul  Goddard,  "Anatomy,  Physiology  and  Pathology  of 


THE    HEAD,    FACE,    JAWS    AND   TEETH  15 

the  Teeth,"  1844:  "Most  prolific  cause  of  irregularity  is  the 
want  of  room  in  the  dental  arches — this  arises  sometimes 
from  a  congenital  defect,  but  more  commonly  from  early 
decay  and  loss  of  the  temporary  teeth,  which  failing  to  keep 
up  the  alveoli,  enables  the  jaw  to  contract  and  thus  afford  too 
little  room  for  the  permanent  set." 

The  author,  after  seven  years  of  constant  study  and  scien- 
tific research,  in  a  paper  read  before  the  Dental  Section  of 
the  Ninth  International  Medical  Congress  in  1887,  entitled, 
"Etiology  of  Irregularities  of  the  Jaws  and  Teeth,"  called 
attention  to  the  following  points: 

1.  The  peculiarities  in  the  size  and  shape  of  the  jaw-bone 
may  be  inherited,  but  the  manner  of  the  eruption  of  the  teeth 
cannot  be  transmitted;  that  is,  irregularities  of  the  dental  arch 
per  se  are  not  inherited. 

2.  That  the  muscles  of  the  cheeks  have  nothing  to  do 
with  the  production  of  the  V  or  saddle  arch. 

3.  That  the  only  tissues  involved  are  the  jaw-bone  on  the 
one  hand  and  the  teeth  and  alveolar  process  upon  the  other; 
and  in  1888  (see  Dental  Cosmos),  by  diagram,  he  showed  how 
the  different  deformities  were  produced. 

4.  That  the  incisors  in  the  V-shaped  arch  always  pro- 
trude; in  the  saddle  arch,  never. 

5.  The  manner  of  the  formation  of  the  V  and  saddle 
arches  in  the  arrangement  of  the  teeth. 

6.  No  matter  what  position  the  teeth  may  take,  the 
alveolar  process  is  dependent  upon  the  teeth  for  its  shape  and 
position. 

T.  He  showed  the  difference  between  thumb-sucking 
deformities  and  those  of  the  V  and  saddle  arch. 

In  the  same  paper  on  ' '  Arrest  of  Development  and  Exces- 
sive Growth  of  the  Maxillary  Bones,"  the  author  called  atten- 
tion to  the  fact  that  the  jaws  would  become  arrested  and  exces- 
sively developed  from  constitutional  diseases  in  the  follow- 
ing words:  "The  last,  but  not  least,  of  the  causes  of  arrested 
development  of  the  maxillary  bones,  which  I  shall  mention, 
is  that  due  to  constitutional  diseases  and  the  eruptive  fevers. 
Debilitating  acute  diseases  (fevers,  the  exanthemata),  in  chil- 


16  ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 

dren  are  sometimes  followed  by  sudden  overgrowth  of  bone, 
which  is  quite  noticeable.  This  process  affecting  the  jaw, 
may  account  for  a  certain  proportion  of  those  cases  of  measles 
and  pneumonia  which  are  followed  by  dental  irregularities 
and  maxillary  deformities.  In  some  cases,  however,  the  pro- 
cess is  a  low  grade  of  inflammation,  which  is  followed  by 
atrophy  of  the  jaw,  instead  of  hypertrophy  or  hyperplasia." 
In  a  paper  read  before  the  Section  of  Dental  and  Oral 
Surgery  of  the  American  Medical  Association,  at  Cincinnati, 
May  8,  1888,  the  author  first  classified  the  irregularities  of 
the  teeth  into,  (1)  constitutional,  those  which  develop  with  the 
osseous  system;  (2)  those  due  to  local  causes;  (3)  resume 
2  "  Irregularities  of  the  teeth  cannot  occur  until  they  have 
erupted  and  thus  shown  their  relation  to  each  other  and  to 
the  Jaw."  That  is,  the  deformity  commences  at  the  sixth 
year  and  is  completed  at  the  twelfth  year.  By  diagrams  the 
author  has  explained  how  the  forward  movement  of  the  pos- 
terior teeth  would  produce  the  same  result  as  arrest  of  devel- 
opment of  the  maxillse.  Although  the  jaws  were  sufficiently 
large,  the  result  of  the  forward  movement  would  be  to  develop 
a  V  or  saddle  arch;  hence  the  necessity  of  keeping  the  first 
permanent  molar  in  its  normal  position.  (In  1888,  first  edi- 
tion of  Irregularities  of  the  Teeth.)  In  1889,  the  author  read 
a  paper  before  the  American  Dental  Association,  Saratoga, 
New  York,  on  "  The  Classification  of  Typical  Irregularities 
of  the  Maxillee  and  Teeth,"  the  result  of  a  collection  of  over 
two  thousand  models,  and  an  examination  of  a  thousand  more, 
in  the  collections  of  Dr.  Farrar,  of  New  York,  and  Dr.  Shep- 
ard,  of  Boston,  and  others  in  different  parts  of  this  country 
and  Europe,  making  in  all  over  three  thousand.  This  classi- 
fication was  V,  partial  V,  semi-V,  saddle,  partial  saddle,  semi- 
saddle,  semi-V  on  one  side  and  semi-saddle  on  the  other.  In 
1889,  a  paper  was  read  before  the  Dental  Section  of  the  Amer- 
ican Medical  Association,  at  Newport,  R.  I.,  June  25th, 
entitled,  "Statistics  of  Constitutional  and  Developmental 
Irregularities  of  the  Jaw  and  Teeth  of  Normal,  Idiots,  Deaf 
and  Dumb,  Blind  and  Insane  Persons."  In  1890,  second 
edition  of  Irregularities  of  the  Teeth;  in  1890,  a  paper  read 


THE    HEAD,    FACE,    JAWS   AND    TEETH  17 

at  the  International  Medical  Congress,  Berlin,  "  The  Differ- 
entiation of  Anterior  Protrusion  of  the  Upper  Maxill*  and 
Teeth;"  in  1891,  " Mouth  Breathing  not  the  Cause  of  Con- 
tracted Jaws  and  High  Vaults."  He  showed  by  a  large  num- 
ber of  measurements  and  actual  cases  in  practice  that  the 
vault  was  not  contracted  by  mouth  breathing;  that  con- 
tracted dental  arches  were  as  common  among  low  vaults  as 
high;  that  they  simply  looked  high  because  of  the  contrac- 
tion; that  mouth  breathing  due  to  hypertrophy  of  the  bones 
of  the  nose  and  mucous  membrane,  deformities  of  the  nasal 
bones,  adenoid  growth  and  any  pathological  condition  that 
would  produce  stenosis,  does  not  produce  the  contracted  jaws, 
but  that  all  of  these  conditions  are  due  to  neuroses  of  develop- 
ment. 


CHAPTER  II. 

CHANGES   IN  CLIMATE. 

Man,  in  his  development,  must  or  should  be  studied  as  an 
animal,  and  from  two  great  standpoints,  because  of  the 
structures  involved.  First,  the  nervous  system,  and,  second, 
the  osseous  or  bony  system.  The  changes  that  take  place 
resemble  the  moulding  of  a  human  being  in  clay.  If  we 
watch  the  sculptor  as  he  prepares  his  figure  we  perceive  at 
first  how  ungainly  and  ungraceful  it  appears,  but  as  he  adds 
pieces  of  clay  in  one  place  and  removes  them  from  another, 
we  see  developing  a  most  beautiful  piece  of  art.  Just 
as  the  changes  take  place  in  the  model  of  clay,  so  greater  ones 
take  place  in  man.  Having  accepted  the  Darwinian  theory, 
let  us  call  the  uncouth  model  the  orang  and  chimpanzee; 
then  as  the  figure  passes  through  its  various  changes  until  it 
becomes  a  thing  of  beauty,  so  man,  in  his  vicissitudes,  rises  to 
what  we  might  call  a  perfect  being.  / 

We  have  now  the  framework  upon  which  to  build;  the 
brain  begins  its  development,  and  we  find  the  osseous  system 
built  out  at  one  point,  reduced  at  another,  just  as  the  clay 
model  was  moulded.  The  animal  which  formerly  possessed 
only  instinct  now  begins  to  reason  and  to  think  for  himself. 
When  he  depended  upon  nature  for  his  subsistence  he  had  no 
need  for  reason;  now,  through  the  various  changes  of  climate 
and  conditions,  he  begins  to  collect  material  for  shelter  and 
protection,  and  to  cook  his  food. 

The  development  of  the  nervous  system  is  accomplished 
at  the  expense  of  the  osseous  system.  Thompson  says:* 
' '  The  structure  of  the  face  arose  from  its  parts  having  been 
created  for  the  accommodation  of  the  speech  and  sense  organs, 
and  upon  these  foundations  the  facial  features  were  con- 
structed and  facial  expression  became  possible.  The  inverte- 
brate animals  have  the  special  sense  organs  scattered  over  the 

*Dental  Cosmos,  1890,  pp.  633,  683. 

18 


THE  HEAD,  FACE,  JAWS  AND  TEETH  19 

entire  body,  so  that  there  is  really  no  face,  strictly  so-called, 
until  we  reach  the  vertebrates,  where  the  face  and  special 
senses  are  located  within  a  limited  area  upon  the  front  of  the 
head." 

In  the  animal  depending  upon  its  physical  strength  for  pro- 
tection and  food,  the  bony  framework  is  very  strong.  The 
bones  are  large,  long,  and  the  attachment  of  the  muscles  very 
marked,  thus  indicating  the  muscular  strength.  Ascending  the 
scale  to  man,  the  bones  are  smaller  in  diameter  and  shorter, 
showing  that  the  muscles  are  not  so  large  or  strong.  Like 
changes  also  take  place  in  the  shape  of  the  head,  face,  jaws 
and  teeth,  and  since  man  is  no  longer  compelled  to  procure 
his  food  with  his  teeth  or  protect  himself  with  his  jaws,  the 
jaws  and  teeth  become  smaller  and  change  their  shape.  The 
brain  is  constantly  enlarging  and  changing  its  shape,  and  the 
bones  of  the  head,  particularly  the  parietal  and  frontal, 
expand  forward,  laterally  and  upward,  while  the  temporal 
muscle,  zygomatic  arch  and  jaws  decrease  in  size. 

In  comparing  the  jaws  of  the  orang  and  chimpanzee  with 
that  of  the  negro,  we  find  a  great  difference  in  the  size,  shape 
and  character  of  the  teeth;  and  in  comparing  the  negro  jaw 
with  those  of  the  working  classes,  and  the  latter  with  those  of 
the  well-to-do  class,  who  do  not  perform  physical  labor,  there  is 
as  great  a  change  as  in  the  case  of  the  orang  and  the  negro. 
The  changes  are  the  result  of  the  law  of  compensation.  The 
human  race  has  to  develop  in  an  intellectual  line;  to  seek  a 
higher  plane  and  brain  development  without  any  or  with  lit- 
tle physical  training.  The  result  is  a  fully  developed  brain  and 
a  weak  physical  structure,  which  soon  succumbs  to  death. 
In  the  preparation  of  the  food  of  the  present  time  mastica- 
tion seems  totally  unnecessary,  and  arrest  of  development  of 
the  jaws  and  early  decay  of  the  teeth,  with  a  weak  physical 
frame,  result.  In  comparisons  of  the  shape  of  the  head,  face 
and  general  appearance  of  the  people  of  the  present  time 
with  those  of  our  ancestors,  it  is  plainly  evident  that  the 
human  race  is  improving  in  grace,  beauty  and  intellect,  while 
the  changes  in  the  general  outline  of  the  head,  face  and  jaws 
in  a  few  generations  are  very  marked. 


20  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

It  makes  no  difference  what  views  the  reader  holds  in 
regard  to  the  origin  of  man;  we  shall  observe  from  facts 
which  we  have  been  able  to  glean  here  and  there,  that  there  is 
a  gradual  change  in  the  structure  of  the  bones  of  the  face  and 
jaws  from  the  earliest  race  to  the  present  time,  and  frequently 
we  observe  retrograde  metamorphosis.  As  we  look  upon  the 
different  shapes  of  the  head,  face,  and  jaws  of  different  nation- 
alities, as  well  as  of  the  people  of  one  nationality  at  the  present 
time,  we  must  admit  the  fact  that  great  changes  have  taken 
place  in  past  generations,  and  that  changes  are  still  going  on. 
The  changes  that  are  going  on  around  us  in  almost  every- 
thing, such  as  occupation,  modes  of  living  and  dress,  are 
much  greater.  Three  of  the  greatest  factors,  however,  which 
influence  the  changes  are,  change  in  climate,  intermixture  of 
races,  and  hereditary  influences. 

Taking  this  classification  in  order,  we  have  first,  change 
of  climate.  It  is  a  well-known  fact  that  climate  has  a  great 
influence  over  the  inhabitants  of  a  country  and  their  customs, 
both  physically,  intellectually  and  morally.  The  earliest 
races  were  a  people  among  whom  a  physical  degeneracy  was 
seldom  found.  They  had  a  nomadic  tendency,  consequently 
in  journeying  from  one  country  to  another,  there  was  a 
mingling  with  foreign  races,  (the  latter  of  which  I  shall 
speak  more  fully  on  in  another  chapter)  and  the  various 
changes  of  climate  from  extreme  cold  or  hot,  and  vice  versa^ 
have  at  last  formed  an  entire  new  race.  I  can  do  no  better 
at  this  time  than  to  quote  Dr.  Quatrefages:  "The  human 
species  springing  originally  from  a  single  center  of  appear- 
ance is  now  universally  distributed.  In  their  innumerable 
travels,  its  representatives  have  encountered  the  widest 
difference  of  climate  and  the  most  opposite  conditions  c»f  life, 
and  now  inhabit  both  the  polar  and  equatorial  regions.  It 
must,  therefore,  have  possessed  the  necessary  aptitudes  for 
accommodating  itself  to  all  the  natural  conditions  of  exist- 
ence; in  other  words,  it  must  have  had  the  power  of  becom- 
ing acclimatized  and  naturalized  in  every  place  where  we 
meet  with  it." 

Certain  monogenists  have  held  that  a  human  race  could 


THE  HEAD,  FACE,  JAWS  AND  TEETH  21 

not  effect  a  change  of  extreme  climate  without  the  loss  of 
life,  while  others  maintained  exactly  opposite  opinions.  At 
any  rate,  we  know  that  many  races  have  passed  these  two 
extremes,  but  it  causes  an  entire  change  in  the  structure  of 
the  offspring,  both  in  man  and  beast  as  well  as  fruit  and 
vegetables.  We  know  that  the  wool  of  sheep  is  different  in 
each  state  of  the  United  States,  and  an  expert  wool  dealer 
can  tell  by  the  feeling  from  what  part  oi  the  country  or  what 
state  it  has  come.  The  same  changes  take  place  with  the 
hog.  In  Russia,  the  hog  has  long,  stiff,  rough  bristles  with 
soft  ends  and  long  roots,  with  a  large  amount  of  wool  inter- 
mixed for  the  purpose  of  keeping  the  animal  warm.  The 
color  is  gray,  black,  yellow  and  white.  In  Germany,  the 
domesticated  hog  has  short,  slightly  rough  bristles  with 
small  roots.  The  color  is  gray  and  black.  The  French  hog 
has  short  and  soft  bristles  with  very  little  wool.  The  color 
is  white  and  yellow.  In  India,  the  bristles  are  short  and 
stiff,  intermixed  with  long  hair  with  split  ends;  the  roots  are 
rough  and  large.  The  hog  of  China  has  smooth,  medium 
length  bristles  with  no  roots,  and  the  color  is  black.  In  the 
Southern  part  of  America,  the  wild  hog  has  stiff  bristles;  in 
the  North,  the  domesticated  hog  has  soft  bristles.  The  color 
is  black  and  white.  It  has  been  asserted  that  horses  kept  in 
the  deep  coal  mines  of  Belgium  become  covered  with  a  soft 
velvet  coat  not  unlike  that  of  a  mole,  while  the  change  in 
cattle,  dogs  and  birds  is  perceptible  to  all,  but  the  change 
that  takes  place  in  man  is  equally  as  great. 

The  negro,  perhaps,  has  undergone  the  most  remarkable 
changes  since  being  brought  to  the  United  States;  his  physi- 
ognomy is  changed  entirely.  Keclus  says:  "In  the  space 
of  150  years  they  have  passed  a  good  fourth  of  the  distance 
that  separates  them  from  the  white  race,  as  far  as  external 
appearance  goes, "  while  Quatrefages  declares  that  a  "sub- 
negro  race  has  been  formed.''  However,  they  still  retain 
some  of  their  ancestral  characteristics,  conformed  to  the 
effect  of  climate  and  associations.  We  notice  this  even  in 
the  colored  people  of  the  Northern  and  Southern  states.  In 
the  South  we  find  him  still  under  the  influence  of  slaverv,  or 


22  ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 

rather,  the  effects  of  bondage.  There  are  a  great  number  who 
are  thrifty,  well-to-do  and  educated,  but  the  greater  number 
still  remain  in  ignorance,  are  lazy,  and  take  on  the  character 
and  manners  of  the  poorer  class  of  white  people.  This  is  due 
in  a  great  measure  to  the  high  temperature  of  the  country.  In 
the  North,  where  the  temperature  is  lower,  nearly  all  the 
colored  people  are  educated  and  occupying  good  positions. 
The  theory  has  been  advanced  that  this  is  due  to  the  colder 
climate  arousing  the  people  to  activity.  In  the  Irish  people, 
we  find  the  broad,  massive  jaw  changed  to  a  delicate  one  like 
those  of  the  Americans.  This  is  also  true  of  the  Swede  and 
Norwegian,  while  the  teeth  of  the  Scandinavians  decay  almost 
immediately  on  their  arrival  in  this  country.  This  has  been 
proven  as  due  to  the  change  in  climate,  as  well  as  of  diet.  It 
has  been  well  proven  that  Frenchmen  can  live  perfectly  well 
in  Corsica,  only  they  must  avoid  the  Eastern  coast  marshes, 
which  even  the  natives  themselves  cannot  inhabit. 

Every  race  being  a  resultant  whose  components  are  partly 
the  species  itself,  partly  the  sum  of  the  modifying  agencies, 
has  produced  deviations  from  the  original  stock.  This  is  in 
accordance  with  nature's  laws,  that  still  further  modifying 
causes  produce  conditions  differing  from  any  that  the  race 
has  known  before,  thus  changing  types  in  a  very  marked 
degree. 

The  pilgrims,  who  braved  the  storms  of  the  ocean  and 
landed  on  Plymouth  Rock,  would  doubtless  have  remained  in 
obscurity  had  they  still  continued  to  live  in  the  Old  World, 
but  instead  they  founded  a  country  which  at  this  time  com- 
pares with  any  on  the  globe.  Through  their  bravery  in  with- 
standing the  winters  upon  the  bleak  and  barren  coast  of  New 
England,  and  also  the  fortitude  with  which  they  bore  the 
hardships  and  trials  of  life,  they  have  won  an  everlasting 
fame.  Had  they  landed  upon  any  other  point  than  in  New 
England,  in  all  probability  the  foundation  principles  of  the 
Constitution  of  the  United  States  or  the  Declaration  of  Inde- 
pendence would  never  have  been  written  with  such  fore- 
thought or  decision. 

These  people  and  their  direct  descendants  stood  by  and 


THE    HEAD,    FACE,    JAWS   AND    TEETH  23 

protected  the  infant  republic,  first  from  the  depredations  of 
the  red  man  and  second  from  the  still  greater  power  of  Eng- 
land. 

Many  years  ago,  when  the  government  surveyors  had 
finished  their  work  in  Minnesota,  they  reported  to  the  author- 
ities in  Washington,  D.  C,  among  other  things,  that  it  was 
impossible  for  human  beings  to  live  the  whole  year  in  that 
state,  owing  to  the  extreme  cold  in  winter;  now  not  only  do 
people  live  and  cultivate  the  soil  throughout  the  entire  state, 
but  a  large  city  has  sprung  up  still  farther  north,  and  the 
country  around  has  become  well  populated. 

In  a  lecture,  delivered  by  the  late  Henry  Ward  Beecher, 
after  an  extended  tour  of  this  country,  he  said  that  the  repre- 
sentative men  of  this  country  would  come  from  the  North- 
west. He  believed  that  the  climate  and  its  various  changes 
would  develop  a  race  which  would  be  unequaled  anywhere 
in  America.  I  can  well  remember  fifteen  years  ago  when 
emigrants  were  unable  to  obtain  a  living  throughout  the 
middle  and  western  part  of  Kansas,  owing  to  the  drouth. 
The  soil  would  not  yield  crops,  trees  would  not  grow,  and 
fruits  and  vegetables  could  not  be  cultivated.  Now  the  state 
is  well  populated;  the  finest  fruits  and  vegetables  are  raised; 
the  country  is  well  watered,  and  prosperity  is  noticed  upon 
every  hand.  As  a  marked  illustration  of  the  effects  of  climate 
upon  people,  we  have  only  to  look  at  the  prosperity  and 
growth  of  some  of  our  Western  cities  and  towns.  The 
inhabitants  are  made  up  of  people  from  every  climate.  The 
Spaniards,  Italians  and  Greeks  from  the  balmy  shores  of  the 
Mediterranean,  the  white  and  negro  from  the  sunny  South, 
are  all  transformed  from  their  indolent  habits,  become 
enthused  and  rush  on  to  keep  pace  with  their  brother  from 
the  colder  North.  In  many  cases  this  is  due  to  the  sudden 
changes  in  heat  and  cold,  and  these  changes  in  climate  fre- 
quently produce  sutFering  and  even  death. 

It  has  been  a  disputed  question  among  anthropologists  as 
well  as  doctors  as  to  the  possibility  of  acclimatization  of 
Europeans  in  the  archipelagoes  of  the  great  Mexican  Gulf, 
A  number  of  general  facts  seem  to  leave  no  doubt  but  that 


24  ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 

the  answer  should  l)e  in  the  ajffirmative;  but  the  yellow  fever 
and  its  influence  appear  to  be  particularly  fatal.  The  reader 
must  not  mistake  my  meaning  to  be  that  the  Europeans  can- 
not live  on  these  islands,  for  they  have  occupied  them  since 
the  discovery  of  America,  but  the  climate  seems  to  be  more 
fatal  to  them  than  in  any  other  part  of  the  New  World.  The 
white  race  has  brought  the  negro  to  these  islands,  and  in  the 
course  of  time  they  have  replaced  the  Carribean  race;  but 
though  these  islands  are  among  the  most  favored  spots  on  the 
globe  for  emigration,  yet  the  race  if  left  to  itself  would  almost 
entirely  disappear. 

The  structure  of  the  osseous  system  of  individuals  changes 
greatly.  I  do  not  mean  those  who  have  attained  their 
growth,  but  the  children  taken  to  the  new  country,  and  those 
born  there.  For  instance,  when  Europeans  settle  in  America, 
their  bodies"  and  limbs  become  elongated.  In  all  probability 
this  is  due  to  the  dryness  of  the  atmosphere  causing  more 
evaporation.  Observe  the  stature  of  the  American  Indian; 
the  great  development  of  their  bones  and  limbs  is  the  result 
of  abundant  food,  a  temperate  climate,  and  roving  habits  in 
a  wild  country. 

Some  authors  assert  that  climate  does  not  cause  the  differ- 
ences in  the  races,  and  that  the  intermixture  of  races  causes 
the  difference.  We  all  know  that  intermarriage  has  a  great 
influence,  but  climate,  while,  if  it  has  not  a  greater  influence, 
is  at  the  same  time  one  of  the  prime  factors.  It  is  the  climate 
more  than  any  one  thing  that  has  made  the  Aryan  of  India 
so  different  from  the  Aryan  of  Persia. 

We  all  know  that  the  people  who  live  in  the  limestone 
regions  develop  larger  osseous  systems  than  those  of  other 
parts  of  the  country,  and  also  people  who  live  in  places  sup- 
plied with  water  from  artesian  wells  develop  large-framed 
men  and  women. 

A  change  of  climate  and  soil,  in  cases  of  long  illness,  is 
nearly  always  beneficial,  when  made  at  the  proper  time, 
especiall}^  in  case  of  people  with  weak  lungs,  and  arrest  of 
development  of  children  as  a  result  of  constitutional  diseases. 
The  effects  of  climate  upon  the  individual  either  tend  to  build 


THE    HEAD,    FACE,    JAWS    AND    TEETH  25 

up  or  break  down  the  general  system  of  those  who  have 
obtained  their  growth.  In  such  cases  the  osseous  system  is  not 
changed  materially;  but  it  is  in  the  young  children  brought 
into  the  country,  or  children  born  of  parents  who  have  emi- 
grated, that  the  general  changes  take  place. 

Thus  we  see  that  climate  and  soil  have  a  great  influence  on 
the  inhabitants  of  a  country. 


CHAPTER   III. 

INTERMIXTURE  OF  RACES. 

In  the  preceding  chapter  we  have  shown  that  man  from 
the  earliest  times  was  a  traveler.  He  had  the  same  desire  to 
explore  unknown  regions  and  to  mingle  with  strange  people 
that  he  has  today. 

Let  us  assume  the  fact  that  previous  to  300  years  ago  the 
races  did  not  mingle  as  they  do  now.  Also,  the  tribes 
and  races  that  did  come  together  did  not  present  such  a 
marked  contrast  in  appearance. 

In  the  early  times  the  people  made  only  short  voyages 
along  the  coasts  in  rudely  constructed  vessels,  of  which  the 
caravels  of  the  Spaniard  and  vikings  of  the  Norseman  are 
good  illustrations.  These  vessels  could  not  withstand  the 
heavy  seas  and  high  winds  of  mid-ocean,  and  even  in  many 
cases  the  winds  and  rains  which  swept  along  the  coast  doubt- 
less carried  some  poor  ship  down;  so  that  emigration  by  water 
was  almost  nothing,  and  hence  nothing  was  known  of  distant 
countries  or  races;  but  the  question  arises,  was  it  any  better 
by  land?  The  people  in  their  journey  over  mountains  and 
plains,  through  barren  tracts  of  land,  many  of  their  com- 
panions a  prey  to  wild  beasts,  while  oftentimes  whole  cara- 
vans were  destroyed  by  the  tierce  torrid  winds  of  the  desert, 
overcame  these  great  disadvantages,  and  though  it  took  many 
hundreds  of  years,  and  at  last  populated  European  countries 
and  produced  the  various  types  of  man  now  found. 

We  must  date  the  commencement  of  emigration,  as  well  as 
the  discovery  of  the  New  World,  that  was  eventually  to  pro- 
duce the  marked  changes  that  constitute  the  new  races,  to 
Columbus.  Very  little,  however,  was  accomplished  in  this 
direction  in  this  country  until  a  century  later,  when  the 
mixture  of  blood  became  very  conspicuous,  as  the  result  of 
the  conquest  of  the  Indies,  Mexico  and  Peru,  1515-1534,  and 
still  later  the  landing  of  the  Pilgrims,  1620. 

26 


THE    HEAD,    FACE,    JAWS    AND   TEETH  27 

In  the  nineteenth  century  we  find  that  intermixture  of 
races  and  emigration  has  gone  on  to  such  an  extent  that  we 
sometimes  stop  and  ask  the  questions,  what  shall  we  call  this 
new  race  that  has  sprung  up,  and  is  there  a  pure  race  on  the 
globe  at  the  present  time.  As  regards  the  first,  it  has  never 
been  answered  satisfactorily;  for  the  second,  let  us  take  as 
illustrations  the  Jews,  Chinese  and  Japanese.  I  think  I  am 
quite  safe  in  saying  that  these  are  the  only  pure  races.  Of 
course,  some  few  of  these  have  intermarried,  but  the  nations 
as  a  whole  are  almost  entirely  pure. 

The  great  emigration  and  intermixture  are  due  to  the 
inducements  of  liberty  in  religious  beliefs,  labor,  high  wages, 
liberty  as  opposed  to  oppression,  and  the  desire  of  the  people 
for  better  conditions  and  comforts  in  new  countries,  in  con- 
trast to  the  crowding  and  scarcity  of  work  in  the  old  coun- 
try. 

Traveling  long  distances  by  sea  and  land  has  brought 
together  nations  of  the  greatest  possible  diflerences  in  opin- 
ions, modes  of  living,  and  peculiarities  in  the  structure  of  the 
osseous  system. 

Each  country  has  its  peculiar  type  of  people.  Africa  its 
negroes,  America  its  tribes  of  Indians,  Japan  and  China  their 
own  particular  people,  and  throughout  Europe,  the  white 
races,  each  indigenous  to  its  own  country;  but  how  different 
and  marked  are  the  changes  in  the  osseous  system.  This  has 
been  nicely  illustrated  by  Prof.  Putnam  in  his  collection  on 
anthropology  at  the  World's  Fair,  showing  conclusively  that 
the  marked  changes  are  in  the  size  and  shape  of  the  bones. 

When  a  race  has  lived  in  its  own  country,  without  change 
in  habits  or  mixture  with  other  races,  there  is  no  reason  to 
expect  a  change  in  its  type. 

The  Egyptian  is  a  good  example  of  this.  In  comparing  a 
picture  taken  from  Kameses  II,  about  3,000  years  ago, 
with  the  Egyptian  of  today,  we  can  discover  little  or  no 
change.  The  Ethiopians  on  the  early  Egyptian  bas-reliefs 
have  their  counterparts  among  the  white  Nile  tribes,  while 
we  recognize  in  the  figures  of  the  Phoenician  or  Israelite 
captives,  the  familiar  Jew  of  our  own  day.'     This  illustrates 


28  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

conclusively  that  a  race  may  keep  up  its  special  characters 
plainly  recognizable  for  over  thirty  centuries. 

One  of  the  most  conspicuous  examples,  and  the  one  most 
familiar  to  all  English  speaking  people,  is  that  between  the 
negro  and  the  white  race.  The  mulatto  complexion  and  hair 
are  intermediate  between  those  of  the  parents,  and  new  grades 
of  complexion  appear  in  the  offspring  of  the  white  and 
mulatto,  the  latter  l)eing  known  as  the  quadroon.  The  inter- 
mediate character  in  all  race  mixtures,  however,  has  a  ten- 
dency to  revert  to  one  or  the  other  parent  in  a  more  or  less 
degree.  Referring  again  to  the  colored  people  for  example, 
we  see  that  here  the  ofi'spring  presents  all  the  characteristics 
of  the  mixed  race.  Some  of  the  children  may  resemble  the 
white  father  in  color,  but  have  the  features  of  the  mother; 
rarely  do  we  find  two  children  whose  parents  are  one  white 
and  the  other  colored,  that  have  the  same  color,  or  whose  hair 
is  the  same.  The  greatest  change,  other  than  color,  is  the 
hair.  The  mulatto's  hair  is  an  intermediate  between  the 
short,  crisp,  woolly  hair  of  the  negro  and  the  hair  of  the 
white  man.  When  malattoes  marry  into  their  own  race — that 
is,  the  colored  race — in  most  cases  their  offspring  will  take  on 
the  full  negro  type,  but  if  a  mulatto  marries  any  other  race, 
the  offspring  rarely  has  any  of  the  negro  features;  sometimes, 
however,  they  will  revert  to  their  negro  ancestors. 

A  mixed  race  invariably  arises  where  the  races  inhabit 
the  same  district,  and  within  the  last  few  centuries  it  is  a 
well-known  fact  that  a  large  fraction  of  the  world's  popula- 
ti(m  has  actually  come  into  existence  by  race-crossing.  This 
is  more  evident  on  the  American  continent  than  elsewhere, 
for  such  districts  as  Mexico,  which,  since  the  Spanish  con- 
quest, has  become  largely  populated  with  descendants  of 
Spaniards  and  native  Americans.  The  intercrossing  of  races 
has  given  anthropologists  a  wide  field  in  the  endless  shades  of 
diversity  among  mankind.  It  is  a  hopeless  task  even  to 
classify  each  group  into  a  special  race.  The  difficulty  of 
making  a  systematic  assignment  of  each  man  to  his  particu- 
lar race  is  well  illustrated  among  the  Arabs.  There  is  a  class 
of  them  who  speak  the  Arabic  tongue,  are  Moslem  but  not 


THE  HEAD,  FACE,  JAWS  AND  TEETH  29 

Arabs  proper,  neither  are  they  Egyptians  of  the  old  king- 
dom, but  of  a  land  where  the  Nubian,  Copt,  Syrian  and 
Bedouin  have  mingled  for  ages;  hence  their  ancestry  may 
have  come  from  three  quarters  of  the  globe. 

In  India,  a  variety  of  complexion  and  feature  is  found 
Avhich  cannot  be  classified  by  race  exactly,  but  we  must 
remember  the  distinct  varieties  of  men  who  have  contributed 
to  this  dense  population,  the  dark-brown  indigenes,  or  hill 
tribes,  the  Mongolians  from  the  frontiers  of  Thibet,  together 
with  the  fair  Aryans  or  Indo-Europeans  from  the  Northwest, 
and  this  mixture  going  on  for  ages  has  produced  numberless 
crosses.  So  in  Europe,  the  fair  nations  of  the  Baltic  and  the 
darker  nations  of  the  Mediterranean  by  their  crossing  have 
produced  an  indefinite  diversity  of  brown  hair  and  interme- 
diate complexion. 

Heterogeneous  races  have  by  intermixture  given  rise  to 
raceless  masses,  people  which  present  no  fixed  characters,  and 
who  form,  so  to  speak,  dispersive  circles  around  the  original 
species,  which  at  their  points  of  contact  become  confluent.* 

Pure  races  exhibit  a  more  uniform  type,  and  the  mixed 
races  a  variegated  type,  and  this  variation  increases  as  the 
intermixture  increases,  f 

When  we  hear  of  a  people  which,  despite  a  low  state  of 
intellectual  culture,  exhibits  a  variety  in  features,  nose,  lips, 
as  for  instance  amono-  the  Tschuvashes,  we  shall  not  be  wronsr 
in  considering  it  as  of  mixed  origin. 

The  Samboes,  descended  from  an  Indian  and  negro,  in  the 
south  of  the  United  States,  present  sometimes  crisp  hair  with 
copper-colored  skin,  and  all  other  Indian  characteristics,  and 
sometimes  the  coarse  hair  of  the  Indian  upon  the  head  of  the 
negro,  with  a  black  skin.  There  is  here  no  intermediate  type 
produced  by  intermixture,  but  there  is  produced  an  irregular 
agglomeration  of  the  characteristics  of  the  parent  forms.  ^  It 
might  be  demonstrated  that  these  difl'erent  races,  the  people 
of  Northern  Italy,  Southern  Germany,  Great  Britain,  not  to 

*Vogt. 

+  Waitz,  "Anthropology." 

i  Ibid. ;  Forey  on  Schoolcraft. 


30  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

speak  of  the  United  States,  where  the  fusion  of  blood  is  prob- 
abl}^  inexplicable,  have  given  birth,  by  their  intermixture,  to 
ethnological  moditications  still  recognizable.  In  all  these 
countries  the  instability  of  anthropological  characters  is  in 
contrast  with  the  fixity  which  marks  pure  races.  '' 

The  union  of  different  nationalities  is  more  common  in 
this  country  than  in  any  other;  due,  no  doubt,  to  the  fact 
than  people  of  all  countries  and  nationalities  tlock  here  to 
better  their  condition  in  life.  We  would  expect  that  marriages 
would  naturally  result  from  a  commingling  of  these  foreign 
elements,  especially  in  the  newer  parts  of  the  country.  Immi- 
gration of  different  nationalities,  and  intermarriages  which 
take  place,  tend  to  improve  the  race  physically  in  some 
respects,  and  in  others  degeneracy  results.  Inasmuch  as  the 
tendency  in  this  country  is  toward  the  production  of  small 
jaws,  while  the  jaws  of  foreigners  are  much  larger,  the  off- 
spring of  such  marriages  would  naturally  inherit  the  extreme 
peculiar  characteristics  of  both  parents.  Such  peculiarities 
are  very  noticeable  in  the  tribe  of  Marshpee  Indians  on  Cape 
Cod.  The  present  people  are  descendants  of  the  original 
Indians,  who  married  among  the  whites,  negroes  and  Portu- 
guese. These  intermarriages  have  continued  down  to  the 
present  generation,  making  seven  or  eight  generations  in  all, 
until,  as  Professor  Putnam,  of  Harvard  College,  has  said, 
•'there  is  very  little  Indian  blood  left."  There  are,  however, 
three  or  four  of  the  older  people  who  still  retain  all  the  char- 
acteristics of  the  early  Indian  race.  It  is  very  interesting  to 
observe  the  peculiar  features  of  the  younger  generation,  a 
few  of  which  I  will  describe.  A  little  girl,  eight  or  ten  years 
of  age,  presented  all  the  peculiarities  of  the  negro, — broad 
nose,  thick  lips,  dark  skin,  with  the  long,  straight,  black  hair 
of  the  Indian,  reaching  nearly  to  her  waist.  Another,  Mrs. 
H.,  whose  mother  is  half  white,  father  negro;  she  is  full 
negro  in  appearance,  except  the  skin,  which  is  copper- col- 
ored. The  jaws  are  slender  in  outline,  and  quite  unlike  the 
father's.  Mr.  K.,  great-grandfather,  negro;  mother,  Indian; 
father,  three-fourths   Indian,     He   has   large  jaws  like  the 

*  Broca,  "  Hybridity  in  Genus  Homo." 


THE    HEAD,    FACE,    JAWS    AND   TEETH  31 

negro;  long,  straight  hair,  copper-colored  skin,  high  cheek- 
bones. Mr.  P.,  maternal  grandfather,  Portuguese;  paternal 
grandfather,  negro;  paternal  grandmother,  Indian  and  white; 
maternal  grandmother,  Indian  and  negro.  He  has  fine  curly 
short  hair,  negro  nose,  high  cheek-bones,  large  jaws  and 
teeth,  upper  and  lower  teeth  occlude.  I  could  give  from  my 
note-book  many  other  illustrations  of  these  marked  changes 
in  bone-structure,  and  also  peculiar  mixtures,  produced  by  the 
union  of  different  nationalities,  but  enough  has  been  said  in 
regard  to  this  tribe  to  show  that  when  there  is  a  union  of  dif- 
ferent nationalities,  the  offspring  inherit  not  only  the  peculiar- 
ity of  one  parent,  but  frequently  possess  a  mixture  of  the 
peculiarities  of  both.  A  similar  class  of  people,  made  up  of  a 
union  of  Indians  and  negroes,  is  located  in  South  Carolina, 
and  called  by  the  people  "Red  Bones."  They  have  been  thus 
described  in  an  interview  with  Senator  Hampton:  "They 
live  in  small  settlements  at  the  foot  of  the  mountains,  and 
associate  with  none  but  those  of  their  own  race.  They 
resemble  in  appearance  the  gypsies,  but  their  complexion  is 
red.  This  intermixture,  which  is  common  in  the  Carolinas, 
produces  marvelous  results.  It  takes  the  kink  out  of  the  hair 
of  the  African,  strengthens  his  features,  and  improves  him  in 
every  way  except  in  temper." 

These  inherited  peculiarities  do  not  cease  at  the  first  gen- 
eration, but  are  transmitted  to  at  least  the  seventh  or  eighth 
generation,  as  I  have  shown  in  the  cases  of  the  Marshpee 
Indians.  It  would  seem  that,  from  these  cases,  race  peculiar- 
ities under  favorable  circumstances  might  be  carried  on  inde- 
finitely. There  is  a  tendency  on  the  part  of  these  Indians, 
due  no  doubt  partly  to  the  mixture  of  white  blood  and  partly 
to  the  soil,  climate  and  environment,  to  take  on  the  general 
make-up,  as  regards  the  osseous  system,  of  the  native  white 
people,  but  far  as  my  investigations  went,  I  was  unable  to 
observe  the  high  vault,  irregularity  of  the  teeth,  and  the 
neurotic  condition  so  noticeable  among  the  native  white 
people.  While  they  possess  the  same  facilities  for  schooling, 
they  lead  a  very  quiet  life  of  farming,  fishing  and  out-door 
work  generally.     The  trades,  professions,  and  such  lines  of 


32  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

work  are  not  sought  after,  and  hence  neurotic  conditions  are 
not  found. 

The  improvement  of  the  "  Red  Bones  "  over  the  negro 
by  "' straightening  his  features,"  mentioned  by  Senator  Hamp- 
ton, must  necessarily  consist  of  a  change  in  the  bones  of  the 
face.  These  changes  must  be  brought  about  by  the  union  of 
the  negro  with  the  Indian,  producing  children  not  unlike 
those  already  mentioned  in  connection  with  the  descendants 
of  the  Marshpee  Indians.  Americans  are  all  familiar  with 
the  changes  that  have  taken  place  in  the  features  of  the 
negro,  due  to  their  consorting  with  the  whites.  The  lower 
jaw  of  the  children  diminishes  in  size  from  generation  to 
generation,  and  the  anterior  lobes  of  the  brain  increase  pos- 
teriorly, the  vertical  portion  of  the  frontal  bone  assuming 
more  of  a  right  angle  with  the  horizontal  portion.  In  this 
manner  the  octoroon  and  quadroon  acquire  in  many  cases 
beautiful  features. 

That  mankind  was  already  divided  into  a  few  great  main 
races,  in  remote  antiquity,  will  go  far  to  account  for  the 
innumerable  slighter  varieties  which  shade  into  one  another. 

In  speaking  of  the  mixed  races  which  come  to  this 
country,  we  must  not  lose  sight  of  the  fact  that  the  neurotics 
and  degenerates  of  all  the  countries  of  the  world  either  come 
herefrom  the  great  inducements  ofiered  or  are  exiled,  and 
when  they  intermarry  with  our  own  population,  the  result  is 
a  native  class  of  degenerates  made  up  of  all  the  deformities 
of  the  brain  and  osseous  system  that  are  known  to  civiliza- 
tion. As  early  as  250  years  ago  this  class  of  the  degenerates 
settled  in  Pennsylvania,  Virginia,  but  more  particularly  in 
Georgia.  The  result  of  the  accumulation  of  paupers  and 
degenerates  has  flooded  the  country  and  lowered  the  standard 
of  mankind.  As  will  be  found  in  another  chapter,  this  taint 
has  crept  out  in  otherwise  respectable  families. 

What  we  have  found  to  be  true  of  the  people  of  this 
country  is  also  true  of  our  English  cousins.  Here  we  find 
the  deformities  more  marked  than  in  this  country,  or  even 
among  ihe  other  nationalities  of  Europe. 

In  prehistoric  times,  and  even  as  late  as  the  Roman  Con- 


THE  HEAD,  FACE,  JAWS  AND  TEETH  83 

quest,  the  natives  of  Britain  were  a  race  of  immense  stature. 
It  has  been  stated  that  captives  taken  to  Rome  were  the 
tallest  people  in  the  entire  city. 

Of  all  the  races  of  Europe  the  English  are,  perhaps,  the 
most  mixed.  The  English  may  be  considered  as  a  race  result- 
ing from  the  intermarriage  of  the  Angles  and  Saxons  with 
the  native  inhabitants  of  the  British  Isles  prior  to  the  Saxon 
invasion.  According  to  Prof.  Huxley,  Britain  was  popu- 
lated by  a  dark  and  a  fair  race.  The  dark  race,  resembling 
the  Iberians,  inhabited  the  western  parts,  while  the  fair  race, 
resembling  the  Belgian  Gauls,  the  eastern  districts  of  the 
island.  At  the  time  of  the  Roman  Conquest  the  language  of 
Britain  was  wholly  Celtic,  but  the  land  was  still  in  the  pos- 
session of  the  two  races.  Subsequent  invasions  failed  to  alter 
the  relation  of  these  stocks,  though  they  spread  a  third  wave 
of  language  (Teutonic)  over  the  entire  Celtic-speaking  area, 
leaving  only  traces  of  the  old  tongue  in  Wales,  Ireland,  Scot- 
land and  Isle  of  Man.  About  the  fifth  century  after  Christ, 
the  Angles  and  Saxons  invaded  Bril  ain  and  mingled  with  the 
Celtic-speaking  inhabitants,  who,  together  with  the  few  remain- 
ing Romans,  peopled  Britain.  Then,  the  first  invasion  of  Great 
Britain  by  the  Normans  and  Danes  during  the  ninth,  tenth 
and  eleventh  centuries  added  to  this  blood,  already  so  mixed, 
another  foreign  infusion.  Figuier,  in  his  "Human  Race," 
says :  '  'The  level  plains,  which  are  as  a  rule  met  with  in  England, 
are  not  favorable  to  the  development  of  the  lower  extremities, 
and  it  is  a  fact  that  the  power  of  the  English  lies  not  so  much 
in  the  legs  as  in  the  arms,  shoulders  and  loins.  The  fist  is 
an  Englishman's  natural  weapon,  either  for  attack  or 
defense."  The  changes  which  have  taken  place  in  the  size  of 
the  jaws  between  the  early  Britons  and  English  people  of  the 
present  day  are  of  the  most  marked  character.  By  actual 
measurement  of  the  superior  maxilla,  from  the  outer  surface 
of  the  first  molar  upon  one  side  to  the  outer  surface  of  the 
other,  there  is  a  difference  of  .32  of  an  inch,  showing  that  the 
jaws  have  been  gradually  growing  smaller.  If  the  measure- 
ments had  been  taken  from  the  outer  surface  of  the  second 
bicuspids  a  greater  change  would  have  been  noticed,  because 


34  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

of  the  fact  that  degeneracy  of  the  jaws  takes  place  anterior  to 
the  first  permanent  molar. 

Anthropologists  claim  that  in  the  earliest  history  of  the 
world  man  was  divided  into  two  great  classes — brachy- 
cephalic,  or  broad  head,  and  dolichocephalic,  or  long  head. 
There  is  a  difference  of  opinion  among  anthropologists  as  to 
what  constitutes  a  broad  or  long  head.  Broca's  division  is 
perhaps  the  most  authentical.  He  gives  five  divisions,  as  fol- 
lows: 

True  dolichocephalic,  -  below  750 

Sub-dolichocephalic,  -  -      750  to  778 

Mesocephalic,  -  -  778  to  800 

Sub-brachycephalic,  -  -       800  to  833 

True  brachycephalic,  -  above  833 

While  Professor  Flower,   of  the  Royal  College  of  Sur- 
geons, England,  simplifies  this  table  by  the  following: 
Dolichocephalic,  -  -  below  750 

Mesocephalic,  -  -  -     750  to  800 

Brachycephalic,  -  -  above  800 

These  measurements  are  obtained  by  dividing  the  extreme 
breadth  of  the  skull  by  the  length  from  front  to  back  and 
multiplying  by  100.  The  general  subdivisions,  as  given  by 
anthropologists,  are:  the  black  race,  dolichocephalic;  the  wliite 
races,  mesocephalic,  and  the  yellow  races,  brachycephalic; 
the  Lapps,  brachycephalic,  and  the  English,  mesocephalic, 
while  the  North  Germans  are  sub-dolichocephalic,  and  the 
South  Germans  sub-brachycephalic. 

.  It  is  not  the  intention  of  the  writer  to  discuss  the  antiquity 
or  the  classification  of  these  different  types  of  man.  That 
they  did  exist  very  early  in  the  history  of  the  world  is 
amply  illustrated  by  the  specimens  that  have  been  exhumed 
in  different  parts  of  Germany  and  England,  and  are  to  be 
seen  in  the  different  museums  throughout  Europe. 

From  the  earliest  history  down  to  the  present  time  these 
two  types  have  intermingled,  and  are  to  be  seen  to  a  greater 
or  less  extent  among  all  the  nations  of  the  world.  The 
tendency  seems  to  be  for  the  dolichocephalic,  or  long-headed 
race,  to  merge  or  change  into  the  brachycephalic,  or  broad- 


THE    HEAD,    FACE,    JAWS    AND   TEETH  35 

headed  people,  although  the  evolution  of  the  brain  would  at 
first  contradict  this  statement.  The  evolution  of  the  brain 
has  developed  anteriorly  by  a  gradual  pushing  forward  of 
the  frontal  bones.  The  original,  or  pure  African,  type  repre- 
senting the  lowest  form  of  man,  shows  how  quickly  in  the 
colored  race  the  changes  from  the  dolichocephalic  to  the 
brachycephalic  have  taken  place  by  changes  of  climate  and 
intermixture  of  races.  The  dolichocephalic,  or  long-headed 
type  of  the  African,  has  changed  during  the  past  two  or  three 
generations  to  a  mesocephalic  and  brachycephalic. 

Upon  the  examination  of  about  2,000  colored  people  in 
Cliicago,  I  have  been  unable  to  find  but  six  who  possessed 
dolichocephalic  heads.  The  others  were  mesocephalic  and 
brachycephalic,  with  their  modifications.  This  tends  to  show 
that  changes  in  climate  and  intermixture  with  the  Indian  and 
white  races  have  completely  changed  the  shape  of  the  head  as 
well  as  the  entire  physical  structure  of  the  African.  The 
sudden  changes  in  type  are  not  confined  to  this  race,  but  are 
found  among  some  of  the  New  England  families.  This  leads 
me  to  believe  that  these  sudden  changes  in  type  could  take 
place  in  the  shape  of  the  head  from  dolichocephalic,  and 
vice  versa  in  any  family  under  similar  conditions  in  any  part 
of  the  world.  As  we  have  seen,  marked  changes  in  the  shapes 
of  the  head  result  from  change  of  climate  and  mixture  of 
races;  the  shape  of  the  jaws  must  necessarily  change  to  cor- 
respond with  the  shape  of  the  head. 

The  changes,  which  occur  in  the  general  outline  of  the 
head  and  jaws  in  a  few  generations,  are  excellently  illus- 
trated in  the  following  portraits  of  a  noted  family  in  this 
country.  Four  generations  are  here  shown,  in  the  order  in 
which  they  lived.  The  cuts  are  drawn  from  daguerreotypes 
and  photographs,  and  of  course  are  useful  only  in  giving  the 
general  outlines  of  the  shapes  of  the  heads.  Unfortunately, 
the  hair  upon  the  faces  depicted  in  the  last  two  illustrations 
forbids  any  comparison  being  made  so  far  as  the  jaws  are 
concerned.  There  is,  however,  such  a  contrast  in  the  shapes 
of  the  heads  that  those  who  are  familiar  with  craniology  can 
readily  trace  the  changes  which  would  naturally  take  place 
in  the  shapes  of  the  jaws. 


36 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


Fig.  1  represents  a  man  born  in  Connecticut  in  17(!1;  died 
in  1826.  This  picture  represents  a  dolicliocephalic  head  with 
massive  jaws,  prominent  lips,  especially  the  upper.    The  nose 


Fiff.  1. 


Fig.  2. 


Fig.  .3. 


Fig.  4. 


THE  HEAD,  FACE,  JAWS  AND  TEETH  37 

is  long,  and  the  eyes  are  set  close  together;  the  forehead  very 
high  and  straight. 

Quite  a  change  is  noticeable  in  the  second  generation, 
depicted  in  Fig.  2.  The  face  is  not  so  long,  the  lateral  diam- 
eter of  the  head  is  larger,  tTie  forehead  more  prominent,  and 
the  eyes  are  a  little  farther  apart.  The  nose  is  about  the 
same  length,  and  while  there  is  a  general  resemblance  about 
the  mouth  and  chin,  the  distance  from  the  front  of  the  chin 
to  the  tip  of  the  nose  is  not  quite  so  long.  The  change 
seems  to  be  in  the  shortening  of  the  chin. 

Fig.  3  shows  still  further  change.  The  forehead  is  broader 
and  less  retreating  than  either.  There  is  perceptibly  less 
prognathism.  There  is  less  prominence  in  the  supraorbital 
region. 

Fig.  4  shows  a  head  just  the  opposite  of  Fig.  1.  This  is 
a  brachycephalic  head.  The  head  is  nearly  round;  forehead 
full;  eyes  set  in  the  head  to  correspond  with  the  width  of  the 
head;  nose  broad;  upper  lip  short,  and  lower  jaw  much 
broader  than  in  Fig.  1.  The  lower  jaw  is  evidently  much 
shorter  in  a  perpendicular  line.  These  changes  are  due  to  a 
protruding  forehead,  receding  chin,  and  delicate  features. 

We  have  seen  by  these  cuts  that  in  four  generations 
shapes  of  heads  have  entirely  changed.  It  is  possible  that  the 
reverse  changes  from  brachycephalic  to  dolichocephalic 
might  take  place,  but  I  am  of  the  opinion  that  the  long- 
headed races  are  gradually  becoming  extinct  and  the  broad- 
headed  race  taking  their  place. 

Anthropologists  are  familiar  with  the  changes  that  take 
place  in  the  jaws,  corresponding  to  the  changes  in  the  head. 


CHAPTER  IV. 

HEREDITARY  INFLUENCE. 

It  is  not  the  intention  of  the  author  to  say  more  than  a 
few  words  upon  the  subject  of  heredity;  so  much  has  been 
written  that  it  is  useless  to  enter  deeply  into  the  subject.  It 
will  only  be  attempted  here  to  give  a  few  facts  pertaining  to 
heredity  in  general,  thus  bringing  the  matter  more  vividly 
before  the  reader;  but  later  on  heredity  as  relating  to  the 
special  study  of  the  cranium,  face,  nose,  jaws  and  teeth  will 
be  discussed. 

Anthropologists  agree  that  heredity  is  that  influence 
which  foreordains  that  the  offspring  shall  be  in  the  likeness 
of  the  parents.  This  is  Nature's  great  law,  and  it  is  uni- 
versal from  the  lowest  forms  of  vegetable  and  animal  life  to 
man. 

It  is  marvelous  what  an  extent  the  hereditary  influence  of 
each  of  the  parents  has  over  the  offspring,  with  such  dif- 
ferent characteristics,  however,  that  it  is  almost  impossible 
to  speak  of  both  in  the  same  terms.  Each  individual  is 
single  or  simple  in  one  aspect  and  composite  in  another.  We 
seem  to  inherit  bit  by  bit,  or  piece  by  piece,  this  element 
from  one  parent,  that  from  the  other,  until  an  intermediate 
individual  is  formed.  These  elements,  however,  are  liable  to 
some  small  changes  during  the  process  of  transmission.  The 
child  receives  life  from  his  parents,  and  with  that  life  takes 
up  a  certain  estate  of  moral,  mental,  and  physical  characters. 

The  inheritance  of  a  trait  of  bodily  figure,  character  or 
action  is  a  mystery  as  great  as  the  apparently  sudden  change 
in  a  race,  which  for  many  generations  has  produced  a  seem- 
ingly unchanging  succession  of  attributes — bodily,  mental  or 
physical. 

Peculiarities  of  structure,  however,  possess  a  double 
interest,  both  of  variation  and  persistence.  Science  has  as 
yet  failed   to   find   the  cause  of   these  peculiarities.     They 

38 


THE    HEAD,    FACE,    JAWS   AND    TEETH  39 

appear  in  a  family,  from  what  source  no  one  knows,  and  there 
they  remain  as  hereditary  traits,  inherited  intermittently  or 
regularly.  We  shall  be  able,  in  the  study  of  the  face,  jaws  and 
teeth,  to  show  quite  clearly  how  modification  in  structure  is 
handed  down  from  parent  to  child. 

Heredity  is  often  dependent  upon  climate,  soil  and  inter- 
mixture of  races.  While  children  are  inclined  to  inherit 
parental  qualities,  yet  the  tendency  is  eventually  to  develop 
a  race  like  the  indigenous  stock  referred  to  in  the  chapter  of 
climate.  In  other  words,  climate  and  soil  modify  the  dif- 
ferent generations  to  such  an  extent  that  in  the  period  of  five 
to  ten  generations  the  offspring  will  assume  the  outward 
appearance  and  also  the  habits  of  the  people  with  whom  they 
associate. 

In  an  area  of  a  few  hundred  miles  in  Europe,  we  find 
the  Italians,  Germans,  French,  Spaniards,  Russians  and 
Bohemians,  each  with  different  features,  customs  and  modes 
of  dress.  In  the  same  area  in  the  United  States,  the  native 
Indians  of  the  several  tribes,  have  the  same  different  char- 
acteristics in  features.  Transport  a  French  colony  to  Russia, 
the  future  generations  will  conform  to  Russian  type  (though 
they  do  not  intermarry);  that  is,  they  will  assume  the  Russian 
customs  and  habits  through  climate,  soil  and  associations. 
In  the  United  States,  these  same  conditions  would  take  place, 
if  the  Penobscot  Indians  of  Maine  or  the  Marshpee  Indians 
of  Cape  Cod  had  emigrated  to  the  western  country.  In  this 
case,  however,  the  changes  would  be  more  marked.  In  the 
course  of  two  or  three  generations,  the  long,  slim  individual 
would  become  more  like  the  short,  thick-set  individual  of  the 
Sioux  or  Manitoba  tribes,  and  their  peaceful  nature  would 
change  to  the  character  of  the  ferocious  Apache  or  Crow. 

This  is  also  nicely  illustrated  in  comparing  the  inhabitants 
of  today  of  the  Eastern,  Southern  and  Western  states  of  the 
United  States  and  the  negroes  of  the  South  with  those  of  the 
North.  The  people  differ  in  features,  speech  and  modes  of 
living  nearly  as  much  as  if  they  resided  in  different  countries. 

Owing  to  the  fact  that  the  greater  part  of  the  United 
States  has  only  been  lately  developed,  and  emigration  dates 


40  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

back  only  about  one  generation,  and  to  the  intermixture  of 
different  nationalities,  the  fixed  types,  which  are  so  marked  in 
Europe  and  among  the  different  tribes  of  American  Indians, 
are  not  observed  to  such  an  extent,  but  the  transformation  is 
slowly  going  on.  Nisbet  says:  "If  a  Latin-Spanish  colony 
settled  in  Germany,  and  remained  there,  we  are  bound  to 
believe  they  would  eventually  conform  to  the  German  type. 
The  influence  of  the  physical  surroundings  steadily  exerted 
would  gradually  overcome  that  of  heredity,  although  the  pro- 
cess might  occupy  thousands  of  years.  Thus  we  see  that 
heredity  and  physical  conditions  Avork  together  in  the  mould- 
ing of  a  race." 

The  Jews,  from  an  hereditary  point  of  view,  are  also  inter- 
esting. They  inhabit  every  country  of  Europe,  and  though 
they  frequently  intermarry,  and  differ  greatly  in  physical 
characteristics,  still  any  Jew  can  be  told  by  his  nose,  which, 
according  to  Nisbet,  "is  as  much  a  matter  of  heredity 
as  the  thick  lip  of  the  Imperial  House  of  Austria."  The 
German  Jew  differs  from  the  Portuguese  or  even  the  Spanish 
Jew.  Each  may  be  of  pure  Jewish  blood,  but  he  conforms  in  a 
more  or  less  degree  to  the  type  of  the  people  with  whom  he 
associates.  The  hair  and  complexion  are  mainly  affected, 
but  the  expression  and  shape  of  the  features  are  everywhere 
significant  of  Jewish  blood.  Victor  Cherbuliez  has  said  that 
"every  country  has  the  Jew  it  deserves,"  and  to  my  mind 
this  must  be  partially  true,  for  Jews  that  have  lived  for  gen- 
erations under  free  goverments  are  not  so  apt  to  be  as  treach- 
erous and  unreliable  as  those  who  have  lived  under  despotic 
governments.  The  English  and  French  Jews  make  better 
citizens  than  those  living  in  the  eastern  countries  of  Europe. 

Hereditary  peculiarities  are  both  natural  and  acquired. 
By  natural  conditions  we  mean  those  that  are  of  a  physical 
nature,  while  acquired  conditions  are  those  that  come  to  us 
through  habit,  association  or  accident.  De  Quatrefages  says: 
"The  acquired  nature  is,  so  to  speak,  welded  to  the  original 
nature  of  the  being." 

It  is  of  the  natural  conditions,  however,  that  I  wish  to 
speak  most  in  this  chapter.    They  are  everywhere  noticeable; 


THE  HEAD,  FACE,  JAWS  AND  TEETH  41 

sometimes  not  appearing  until  late  in  life,  yet  they  are  rightly 
to  be  called  natural,  unless  they  are  extremely  exceptional  or 
have  never  previously  appeared  in  a  family;  even  if  possessed 
by  some  ancestor,  they  would  still  be  hereditary  and  natural. 
Galton  says:  "Natural  peculiarities  are  apparently  due  to 
two  broadly  different  causes;  the  one  is  family  likeness  and 
the  other  is  individual  variation."  These  seem  to  be  much 
opposed  to  each  other  and  to  necessitate  a  separate  discussion, 
yet  the  reader  can  readily  understand  how  the  offspring  can 
possess  a  general  or  even  an  individual  likeness  to  its  parents 
and  at  the  same  time  have  a  large  amount  of  individual  dif- 
ferences. Thus,  to  my  mind,  family  likeness  and  individual 
variation  are  dependent  upon  each  other,  each  being  different 
effects  of  the  same  cause.  Some  variations  are,  however,  so 
remarkable  that  they  appear  to  belong  to  a  separate  class. 
We  shall  be  able  to  show,  in  a  future  chapter  on  Neuroses  of 
Development,  why  these  marked  differences  exist  between 
the  child  and  parent. 

A  number  of  small  accidents  tend  to  produce  variations 
in  the  different  members  of  a  family;  therefore  it  is  almost 
impossible  to  enumerate  the  qualities  of  an  individual  from 
hereditary  data,  but  we  can  predict  the  average  results  with 
great  certainty. 

The  possibilities  of  inheritance  do  not  differ  much  more 
than  the  varieties  actually  observed  among  the  members  of  a 
large  family.  We  may  have  the  life-histories  of  parents  and 
relatives  and  also  the  offspring.  In  comparing  them,  we  find 
that  each  one's  life  seems  to  run  apparently  in  the  same  line; 
that  is,  the  offspring  from  generation  to  generation  will  have 
some  characteristics  of  his  ancestors. 

Perhaps  there  is  no  one  thing  that  is  inherited  more 
directly  than  disease. 

Family  history  often  shows  that  two  and  three  generations 
have  died  from  inherited  diseases,  and  then  again  it  will  pass 
over  one  generation  and  appear  in  the  next.  The  inheritance 
of  insanity,  and  co-existing  diseases  of  the  brain,  have  about 
the  same  direct   per  cent  that  lymphatic  disease  does;  yet. 


•12  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

lymphatic  disease,  as  an  hereditary  trait,  "dies  out,"'  as  wo 
say,  much  quicker  than  insanity. 

A  good  example  of  this  is  found  among  the  royalty  of 
Europe.  Even  as  far  back  as  the  Cfesars  we  find  this  taint, 
beginning  with  Julius,  though  during  the  entire  reign  of  the 
Caesars  Roman  society  was  so  corrupt  that  the  family  may 
even  be  considered  a  model  one  for  the  times.  But  let  us 
now  observe  the  royalty  of  England,  beginning  with  the 
Plantagenet  period.  According  to  Jacoby,  the  rival  houses 
of  Lancaster  and  York  were  both  degenerate,  the  former 
being  a  family  of  imbeciles,  and  the  latter,  to  use  a  strong 
term,  villains.  The  deformed  moral  imbecile,  Kichardlll, 
nicely  illustrates  the  villainous  nature  of  the  family.  The 
Tudors  Avere  somewhat  similar.  Henry  VII  was  an  epi- 
leptic, and  the  morbid  features  of  Henry  VIII  and  his  chil- 
dren are  familiar  to  every  reader  of  history.  Insanity  of 
the  Stuart  line  dates  from  Marj^  Tudor,  and  was  inherited 
through  Mary,  Queen  of  Scots,  by  James  I  of  England. 
We  shall  return  to  Elizabeth  and  her  successor's  reign  later, 
and  now  follow  the  direct  Stuart  line.  Nisbet  speaks  thus  of 
the  Stuart  line:  "Charles  I  was  perfidious  and  cowardly; 
Charles  II,  depraved,  epileptic  and  without  lawful  issue;  the 
brother  of  the  latter,  James  II,  was  treacherous,  epileptic 
and  vindictive,  mendacious,  cruel  and  ridiculous  to  boot; 
Mary,  daughter  of  James  II,  was  weak-minded  and  childless, 
and  hence  a  prolific  neurotic,  and  not  a  healthy  or  long-lived 
family.  Finally,  Charles  Stuart,  the  pretender,  the  last  of 
his  line,  was  illiterate,  dipsomaniac,  paralytic  and  died 
insane."  But,  to  return  to  the  Stuarts:  several  of  the  chil- 
dren of  Elizabeth  died  young,  and  it  was  through  her 
younger  daughter,  Sophia,  who  became  heiress  to  the  throne, 
that  the  Hanoverian  line  was  established,  and  the  question 
arises,  did  she  bring  this  taint  to  the  throne  ?  For  an  answer 
we  must  look  at  the  careers  of  the  Four  Georges.  In  George 
III,  however,  the  insanity  of  the  Stuarts  re-appeared.  From 
the  Georges  on,  the  occupants  of  the  throne  of  England, 
according  to  Bismarck,  are  the  "crazy  and  scrofulous 
Guelphs,"    among  whom   are  bleeders,  epileptics,  hysterics 


THE  HEAD,  FACE',  JAWS  AND  TEETH  43 

and  other  neurotics,  and  the  taint  is  still  observed  at  the  pres- 
ent day.  History  but  repeats  itself  in  the  royal  families  of 
Spain,  Germany,  Austria  and  Russia. 

I  have  mentioned  the  lives  of  these  royal  families,  with 
the  names  of  which  we  are  at  least  all  familiar,  to  show  that  the 
taint  of  insanity,  and  its  modifications,  is  inherited  from  gen- 
eration to  generation  for  hundreds  of  years;  but  the  common 
inhabitants  of  the  world  are  not  exempt  from  this  taint.  It 
should  be  noted  that  the  great  causes  of  insanity  and  its  modifi- 
cations are  the  result  of  idleness,  drunkenness,  debauchery, 
and  consanguineous  marriages,  and  that  the  consequences  of 
these  conditions  are  a  weak  physical  structure  in  the  progeny, 
which  results  in  early  death  or  insanity,  drunkenness,  epi- 
lepsy, deafness,  mutism,  blindness,  idiocy,  egotism,  genius 
and  brilliancy. 

Few  will  deny  that  what  is  true  of  the  whole  organism  is 
equally  true  of  its  different  parts,  organs,  functions  and  ener- 
gies, and  that  in  the  formation  of  a  new  being,  the  action  of 
heredity  is  divided  into  as  many  varieties  as  there  are  char- 
acters to  be  transmitted.  There  is  a  tendency  on  the  part  of 
each  parent  to  reproduce  itself  in  the  child,  and  consequently 
there  is  a  constant  struggle  between  the  two  natures  in  the 
morphological  growth  of  the  child.  The  more  dissimilar  the 
parents,  the  greater  the  struggle,  and  the  more  certain  the 
predominance  of  leading  characteristics,  and  the  greater  the 
tendency  to  morphological  abnormalities,  arrest  or  excess  of 
development.  The  outcome  of  this  struggle,  assuming 
inequality  of  action  on  account  of  one  parent  being  stronger, 
is  a  number  of  single  combats  in  which  one  or  the  other  of 
the  parents  is  vanquished. 

Diflferences  of  opinion  of  scientists  have  existed  for  many 
years  as  to  whether  acquired  peculiarities  are  capable  of 
inheritance.  Some  of  the  latest  writers  upon  this  subject 
claim  that  they  are  not  inherited,  but  even  Weissman,  the 
strongest  opponent  of  the  inheritance  of  acquired  qualities, 
has  to  admit  the  inheritance  of  epilepsy,  and  Eimer  has  shown 
that  Weissman's  admission  in  the  case  of  epilepsy  must,  on 
Weissman's  own  principles,  be  extended  to  other  neuroses. 


■H  ETIOLOGY  OF   OSSEOUS   DEFORMITIES 

In  a  future  chapter  it  will  be  shown,  by  actual  demonstration, 
that  peculiarities  of  structure,  which  are  known  to  be  the 
result  of  constitutional  diseases,  are  inherited  by  the  suc- 
cessive generations. 

Children  may  resemble  their  parents  in  habits,  manners, 
customs  and  disposition,  yet  be  wholly  unlike  them  in 
structure  as  far  as  the  features  are  concerned,  though  the 
physical  structure  may  be  the  same.  The  effect  of  habits 
and  manners  of  parents  on  the  offspring  is  very  striking. 
It  is  usuall}'  said  that  boys  assume  the  habits  of  the  father 
and  girls  those  of  the  mother.  This  may  be  or  is  so  from 
association. 

Such  peculiarities  as  stammering,  lisping  and  the  like 
may  seem  to  some  scientists  as  referable  to  a  special  class  of 
hereditary  traits,  but  it  appears  to  me  that  this  cannot  be  so, 
and  that  they  are  acquired  habits.  In  my  own  experience  I 
have  known  children  who  both  stammered  and  lisped  either 
because  they  heard  one  or  the  other  of  their  parents  or  play- 
mates do  so.  This  class,  I  believe,  may  be  termed  neurotic 
individuals.  Neurotic  qualities  of  parents  are  often  inherited 
by  the  child,  who  becomes  the  victim  thereb}^  of  contending 
mental  states. 

I  have  purposely  referred  to  inherited  neuroses  and 
degeneracy  in  the  royal  families  of  Europe,  because  in  the 
chapter  upon  Developmental  Neuroses  we  can  more  easily 
understand  why  deformities  of  the  face  and  jaws  are  noticed 
in  otherwise  apparently  healthy  individuals,  as  well  as  in 
idiots  and  feeble-minded. 


CHAPTER  V. 

DEVELOPMENT  OF  THE  CRANIUM  AND  FACE. 

In  early  stages  of  development  the  posterior  part  of  the 
cranium  is  large  in  proportion  to  the  anterior  part.  At  about 
the  second  month  of  foetal  life  the  parietal  region  begins  to 
increase  rapidly  in  volume  along  with  the  greater  develop- 
ment of  the  cerebral  hemispheres;  the  frontal  region  next 
begins  to  increase  in  size,  and  toward  the  latter  part  of  foetal 
life  the  occipital  region  increases  as  the  brain  extends  back- 
ward. The  face  at  birth  is  in  surface  about  one-eighth  of 
the  cranium,  while  in  the  adult  it  is  fully  one-half. 

At  birth  the  face  still  shows  peculiarities  which  resemble 
those  of  the  foetus.  The  ears  are  much  lower  than  in  the 
adult,  the  external  opening  being  but  little  above  the  mouth. 
Racial  distinctions  are  not  at  all  pronounced,  the  children  of 
the  most  strongly  marked  races  showing  great  similarity, 
according  to  the  law  that  the  farther  back  we  go  in  develop- 
ment the  more  generalized  are  all  the  features. 

After  birth  there  are  three  distinct  periods  of  develop- 
ment, the  first  ending  at  about  the  seventh  year,  the  second 
at  about  the  fourteenth,  and  the  last  at  about  the  twentieth 
year. 

The  transition  from  the  first  to  the  second  type  is  quite  a 
striking  one.  The  skull  grows  rapidly  during  the  first  seven 
3^ears.  By  that  time  certain  parts  have  reached  their  definite 
size:  the  circumference  of  the  occipital  foramen,  the  body  of 
the  sphenoid,  the  cribriform  plate  of  the  ethmoid,  and  the 
petrous  portion  of  the  temporal  bone.  The  eruption  of  tem- 
porary teeth,  the  gradual  modeling  of  bones  by  growth,  the 
development  of  muscular  prominences  and  depressions  grad- 
ually change  the  infantile  character  of  the  physiognomy. 

The  face  becomes  longer  in  proportion  to  its  width,  and 
the  jaws  are  shaped  with  reference  to  use  in  mastication.  In 
the  second  period  very  many  of  the  forms  are  already  adult, 

45 


46  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

and,  if  not  at  their  fullest  development,  have  very  nearly 
approached  it.  From  six  to  twelve  the  growth  is  somewhat 
slow.  With  the  approach  of  puberty  a  second  period  of 
active  growth  begins.  This  period  especially  affects  the  face 
and  frontal  portion  of  cranium.  With  this  we  also  note  the 
expansion  of  the  frontal  and  other  air  sinuses.  From  four- 
teen on  there  is  very  little  advance  in  cranial  development. 

The  face  becomes  elongated  in  the  process  of  growth, 
partly  by  the  increased  height  of  the  nasal  fossaa  and  the  adja- 
cent air  sinuses,  partly  by  the  lengthening  growth  of  the 
alveolar  process  and  the  enlargement  of  the  jaws. 

The  base  of  the  skull,  together  with  the  face,  increases 
relatively  in  size  from  birth  onward;  the  skull  as  a  whole,  in 
proportion  to  the  face,  decreasing. 

The  bones  of  the  face  are  developed  by  the  intramem- 
branous  ossification,  with  the  exception  of  the  symphysial 
portion  of  the  inferior  maxilla.  The  nasal  bones  are  each 
developed  from  a  single  center  in  the  membrane  overlying 
the  fronto-nasal  cartilage.  This  center  is  seen  in  the  eighth 
week  of  foetal  life.  At  birth  the  nasal  bones  are  nearly  as 
wide  as  they  are  long,  but  in  the  adult  the  length  is  three 
times  greater  than  the  width. 

The  malar  bones  each  ossify  from  two  centers,  which 
appear  also  in  the  eighth  week. 

The  superior  maxilla  arises  from  four  centers,  termed  the 
pre-m axillary,  maxillary,  malar  and  pre-palatine,  which 
appear  about  the  eighth  week,  and  ossify  rapidly. 

The  portion  of  the  bone  which  lodges  the  incisor  teeth 
arises  from  the  pre-maxillary  nucleus.  The  nasal  process 
and  the  greater  part  of  the  body  arise  from  the  maxillary 
nucleus.  The  portion  of  the  bone  external  to  the  infra- 
orbital groove  arises  from  the  malar  center,  and  the  nasal 
surface  and  part  of  the  palatine  process  arise  from  the  pre- 
palatine  center. 

The  inferior  maxilla  has  six  centers  of  ossification  for  each 
lateral  half. 

These  centers,  all  but  the  splenial,  are  deposited  between 


THE    HEAD,    FACE,    JAWS    AND   TEETH  47 

the  sixth  and  eighth  weeks.  The  splenial  appears  about  three 
weeks  later. 

At  birth  the  inferior  maxilla  consists  of  two  lateral  halves, 
which  unite  during  the  first  year;  union,  however,  is  not  com- 
plete until  the  second  year.  The  most  striking  features  of  the 
skull  at  birth  are  its  relatively  large  size  in  comparison  with 
the  body,  and  the  predominance  of  the  cerebral  over  the 
facial  portion  of  the  skull. 

The  origin  of  the  structural  points,  which  constitute  the 
permanent  expression  of  the  head  and  face,  as  we  have  already 
said,  is  to  be  studied  from  the  standpoint  of  evolution. 

The  bones  of  the  head  and  face  are  shaped  and  clothed 
with  flesh  according  to  the  action  of  past  and  present  influ- 
ences. The  present  influences  are  the  present  needs,  sur- 
roundings and  habits  of  the  individual.  The  past  influences 
shape  the  embryo,  and  mark  the  infant  with  a  likeness  to  its 
parents.  After  birth  the  hereditary  impulse  carries  on  the 
development  of  the  structures  through  the  nervous  system. 
The  types  of  the  parents  and  ancestors  are  mingled  and  modi- 
fied by  present  circumstances,  such  as  climate,  food,  habits 
of  thought  and  action. 

E.  D.  Cope,  in  his  article  on  "The  Development  and  Sig- 
nificance of  Human  Physiognomy,"  has  brought  together  the 
following  statements  in  regard  to  the  changes  in  the  face  and 
head  of  man  during  his  evolution  from  an  animal  to  a  civi- 
lized being. 

The  points  to  be  considered  in  the  structure  of  the  head 
and  face  are  as  follows: 

1.  Kelative  proportion  of  cerebral  and  facial  regions. 

2.  Prominence  of  forehead, 

3.  Prominence  of  superciliary  ridges. 

4.  Prominence  of  alveolar  borders. 

5.  Prominence  and  width  of  chin. 

6.  Relation  of  length  to  width  of  skull. 

7.  Prominence  of  the  malar  bones. 
S.     Form  of  nose. 

9.     Relative  size  of  orbits  and  eyes. 
10.     Size  of  the  mouth  and  lips. 


48  KTIOLOGY  OF  OSSEOUS  DEFORMITIES  OV 

Changes  in  the  above  points  are  traced  from  previous 
conditions  of  man  by  the  study  of  paleontology,  and  by  the 
study  of  the  development  through  the  embryological  exist- 
ence. In  comparing  the  human  head  and  face  with  that  of 
the  order  Quadrumana,  we  notice  the  following  general  dif- 
ferences in  the  shape  of  the  head  and  face.  Numbers  corre- 
spond to  the  list  above  given. 

1.  In  the  ape  the  facial  region  of  the  skull  is  large  as 
compared  with  the  cerebral. 

2.  Forehead  not  prominent,  generally  retreating. 

3.  Superciliary  ridges  more  prominent. 

4.  Edges  of  the  jaws  more  prominent. 

5.  Chin  less  prominent. 

Fig.  5. 


B 

B — Side  view,  after  Cope. 

6.  Cheek  bones  are  more  prominent. 

7.  Nose  without  a  bridge,  cartilages  short  and  Hat. 

S.     Orbits  and  eyes  smaller  (except  in  Nyctipithecus). 

9.     Mouth  small;  lips  thin. 

Should  any  man  possess  any  of  the  above  characteristics, 
he,  in  feature,  becomes  more  like  the  monkey,  as  he  retains 
features  which  have  been  obliterated  in  others  of  his  species 
in  the  process  of  evolution. 

In  studying  from  an  embryological  standpoint,  we  must 
consider  the  head  of  an  infant  at  birth.     (Fig.  5.) 

1.  The  cerebral  part  of  the  skull  greatly  predominates 
over  facial. 

3.  Superciliary  ridges  are  not  developed. 

4.  Alveolar  borders  are  not  predominant. 


THE     HEAD,    FACE,    JAWS   AND   TEETH  49 

8.  Nose  is  without  bridge,  and  cartilages  are  flat  and  gen- 
erally short. 

9.  Eyes  are  larger. 

It  is  evident  that  the  possession  of  these  characteristics  in 
adults  show  them  to  be  infantile  in  that  respect,  and  their 
absence  shows  that  they  have  been  obliterated  in  reaching 
maturity. 

In  reviewing  the  characteristics  of  the  monkey  and  infant, 
we  find  the  following  points  in  common: 

8.     The  nose  without  bridge,  and  cartilages  short  and  flat. 

The  following  points  are  found  to  be  difi^erent: 

1.  Facial  regions  of  skull  larger  as  compared  with  the 
cerebral. 

2.  Forehead  not  prominent. 

3.  Superciliary  ridges  are  more  prominent. 

4.  Edges  of  the  jaws  are  more  prominent. 

It  thus  becomes  apparent  that  as  man  develops  from 
infancy  he  becomes  more  like  the  apes  in  some  important 
parts  of  his  facial  expression.  But  it  may  also  be  noted  that 
there  exists  the  same  difference  between  the  embryonic  and 
adult  monkey  and  the  embryonic  and  adult  man.  The 
change  is  greater  in  degree  in  the  monkey  than  in  man. 

The  following  is  quoted  verlatim  from  Professor  Coper 
"Man  stops  short  in  the  development  of  the  face,  and  is  inso- 
far more  embryonic.  The  prominent  forehead  and  reduced 
jaws  of  man  are  characters  of  "retardation,"  since  it  is  a 
superaddition  to  the  quadrumanous  type  from  both  the 
standpoints  of  paleontology  and  embryology.  The  develop- 
ment of  the  bridge  of  the  nose  is,  no  doubt,  directly  con- 
nected with  the  development  of  the  front  of  the  cerebral  part 
of  the  skull  and  ethmoid  bone,  which,  sooner  or  later,  carries 
the  nasal  bones  with  it. 

If  we  now  examine  the  leading  characters  of  the  physiog- 
nomy of  three  of  the  principal  human  sub-species — the  negro, 
the  Mongolian  and  the  Indo-European — we  can  readily 
observe  that  it  is  in  the  two  first  named  that  there  is  a  pre- 
dominance of  the  quadrumanous  features  which  are  retarded 
in  man;  and  that  the  embryonic  characters  which  predomi- 


50  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

nate  are  those  in  which  man  is  accelerated.  In  race  descrip- 
tion the  prominence  of  the  edges  of  the  jaws  is  called  prog- 
nathism, and  its  absence  orthognathism;  as  compared  with 
those  of  the  Indo-European,  is  as  follows: 

Negro — Nose  flat,  without  bridge  (quadrum.  retard.); 
prognathous  (quadrum.  accel.);  malar  bones  prominent  (quad- 
rum,  accel.);  beard  short  (quadrum.  retard.). 

Mongolian — Jaws  prognathous  (quadrum.  accel.);  nose 
flat  or  prominent,  with  or  without  bridge;  malar  bones 
prominent  (quadrum.  accel.);  beard,  none  (embryonic). 

Indo-European^ — -Jaws  orthognathous  (embryonic  retard.); 
nose  (generally)  prominent  with  bridge  (accel.);  malar  bones 
reduced  (retard.);  beard  long  (accel.). 

The  Indo-European  race  is  the  highest  b}'  virtue  of  the 
acceleration  of  growth  in  a  well-developed  nose  and  beard. 
It  is  superior  in  those  points  in  which  it  is  more  embryonic 
than  the  other  races,  viz.,  the  want  of  prominence  of  the  jaws 
and  cheek  bones,  since  these  are  associated  with  a  greater 
predominance  of  the  cerebral  hemispheres  and  greater  intel- 
lectual power. 

Some  people  are  always  partially  embryonic  in  having  a 
short  face  and  light  lower  jaw.  Such  faces  are  still  more 
embryonic  when  the  forehead  and  eyes  are  protuberant. 
Retardation  of  this  kind  is  frequently  met  with  in  children, 
and  less  frequently  in  women.  The  brain,  or  nervous  system 
as  a  whole,  holds  direct  supervision  over  the  formative  process 
going  on  in  the  face  and  cranium.  We  find  at  birth  the 
brain  relatively  large  and  its  growth  rapid.  During  the  first 
seven  years  of  life  the  brain  attains  to  nearly  its  whole  size 
and  weight,  ninety  per  cent,  in  fact.  The  remainder  of  its 
bulk  Tabout  ten  per  cent)  is  added  very  slowly.  According 
to  Boyd,  and  others,  after  the  age  of  fourteen  the  increase  is 
very  slight,  scarcely  perceptible,  and  after  seventeen  or 
eighteen,  there  is  none;  but  from  my  own  investigation, 
after  the  age  of  eight,  the  brain  slowly  develops.  The  cells, 
however,  are  constantly  taking  on  new  energ}'  and  resistive 
power. 

The  shape  and  form  of  the  face  depends  principally  upon 


THE    HEAD,    FACE,    JAWS    AND   TEETH  51 

the  bony  structure.  The  bones  of  the  cranium  are  developed 
to  form  a  convenient  protection  to  the  brain,  and  they  are 
shaped  accordingly;  the  brain,  expanding  in  the  prefrontal 
territory,  directly  shapes  its  bony  case  to  fit  the  requirements. 
We  see  the  shape  of  the  cranium  depending  directly  on  the 
shape  and  size  of  the  brain.  Not  so  with  the  bones  of  the 
face.  They  seem  to  have  a  more  independent  development, 
which  calls  into  action  some  different  brain  force. 

We  notice  that  there  seems  to  be  an  arrest  of  development 
in  the  bones  of  the  face  at  the  time  when  the  bulk  develop- 
ment of  the  brain  ceases.  This  normally  should  be  at 
about  the  sixth  or  seventh  year. 

The  arrest  of  development  of  the  bones  begins  to  appear 
with  the  arrest  of  bulk  development  of  the  brain,  and  only  is 
complete  when  the  brain  is  completely  formed. 

It  has  been  very  properly  observed  that  the  human  face 
is  actually  a  result  of  arrested  development.  Frontal  peculi- 
arities, common  to  man  and  other  animals,  are  retained  at  birth 
by  the  former,  and  the  flat  face  of  the  white  man  may  be  said 
to  be  an  arrested  foetal  condition.  The  negro  has  the  same 
foetal  appearance  until  puberty,  when  prognathism  begins  to 
develop. 

The  prognathism  of  the  jaws  of  the  negro  is,  I  believe, 
due  entirely  to  the  excessive  development  of  the  inferior 
maxilla.  The  rami  and  the  body  of  the  lower  jaw,  and  also 
the  muscles  of  mastication,  are  very  large  and  massive  as  com- 
pared with  those  of  the  white  man;  while  upon  the  other 
hand,  the  superior  maxilla  is  small  and  more  delicate.  The 
constant  force  of  the  larger  lower  jaw  upon  the  upper  causes 
the  alveolar  process  to  be  carried  forward  and  upward,  thus 
producing  prognathism.  The  law  of  heredit}^,  whereby  the 
offspring  tends  to  reproduce  its  kind,  is  here  nicely  illus- 
trated. This  theory  is  easily  demonstrated  by  the  examina- 
tion of  negro  skulls  in  the  Army  Medical  Museum  at  Wash- 
ington and  at  the  College  of  Surgeons  in  London.  The  negro 
of  today,  especially  those  living  in  the  Northern  States,  pos- 
sess jaws  not  unlike  those  of  the  white  people;  the  zygomatic 
arches   are   smaller,   the  muscles  less   dense  and  rigid,  the 


52 


ETIOLOGY  OF   OSSEOUS   DEFORMITIES  OF 


lower  jaw  less  massive,  and  orthognathism  instead  of  prog- 
nathism exists  to  a  certain  extent.  This  is  brought  about  by 
the  arrest  of  development  of  the  muscles  and  body  of  the 
lower  jaw,  due  to  change  of  climate,  soil,  and  intermarrying 
of  races. 

The  principle  is  illustrated  in  plates  2  and  3  of  my  "Chart 
of  the  Typical  Form  of  Constitutional  Irregularities  of  the 
Teeth." 

The  bones  and  teeth  are  formed  largely  from  the  phos- 
phates of  calcium,  sodium,  etc.,  which  also  afford  material 


Fig.  6.  Fig.  7. — From  Serpa  Pinto. 

for  the  brain  growth.  If  the  compounds  circulating  in  the 
blood  are  consumed  by  an  active  brain,  the  teeth  and  bones 
will  suffer  in  consequence,  and  ossification  will  take  place 
slowly,  the  bones  being  found  to  be  less  massive  at  maturity, 
and,  as  is  generally  the  case  when  there  is  great  mental  activity, 
there  is  less  muscular  activity,  and  the  muscles  are  retarded 
in  their  development,  being  slight  and  requiring  slight 
attachments;  the  ridges  and  protuberances  on  the  bones  are 
likewise  but  slightly  developed,  and  we  note  their  absence  in 
the  external  expression.  The  vomer  ossifies  in  different  races 
at  varying  periods  of  life.  In  the  white  person  it  remains 
cartilaginous  until  comparatively  late  in  life,  about  puberty, 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


53 


when  the  characteristic  nasal  formation  is  accomplished.  But 
in  the  negro,  and  among  some  Mongolians,  ossification  of  the 
septum  takes  place  much  earlier,  and  the  nose  being  thus 
bound  down  to  the  maxilla  the  alee  spread  out  sideways  on 
the  further  facial  growth,  and  the  so-called  flat  nose  results 
(see  Figs.  6  and  7).  These  illustrations  also  show  excessive 
and  arrest  of  development  of  the  lower  jaw. 

Darwin  notes  that  the  high  cheek  bones  of  the  American 
Indian  (Fig.  8)  were  due  to  the  animal  ancestral  persistence 


Fig.  8. 

of  extra  development  of  the  zygomatic  arch.  Clevenger,* 
mentions  the  larger  size  of  the  temporal  muscle  in  ferocious 
animals,  and  the  insertion  of  this  muscle  inside  the  zygoma, 
and  claims  that  if  the  phylogenetic  degeneration  of  the  muscle 
from  lower  animals  to  savage  and  thence  to  civilized  man  is 
not  kept  pace  with  by  the  "cheek  bones,"  then  prominence 
of  the  latter  is  produced. 

In  the  development  of  the  bones  of  the  head  and  face, 
climate,  soil,  and  intermixture  of  races,  and  hereditary  peculi- 
arities, enter    into    the  formation  of    each  distinct  type  of 

*The  American  Naturalist,  July,  1888,  in  an  article  entitled  "  Cerebrology 
.  and  Phrenology." 


54  ETIOLOGY   OF   OSSEOUS  DEFORMITIES 

beings.  Leave  out  any  one  of  these  and  the  type  will  soon 
become  fixed.  In  a  country  like  America,  where  the  climate 
is  so  diversified,  where  different  nationalities  congregate  and 
intermarriage  is  so  common,  deformities  of  the  face  and  jaws 
must  necessarily  result,  and  many  generations  must  have 
passed  by  before  it  is  possible  for  a  fixed  type  to  be  produced 
in  this  country  like  those  of  European  countries. 

There  is,  however,  another  factor  which  must  be  consid- 
ered in  connection  with  the  development  of  the  human  race, 
that  is  not  confined  to  America,  but  can  be  seen  among  all 
civilized  nations,  and  one  that  has  considerable  weight  in  the 
development  of  the  modern  races — that  is.  Developmental 
Neuroses.  This  question  is  of  more  importance  to  us  than 
any  other,  both  from  a  social  standpoint  and  also  as  regards 
the  welfare  of  posterity.  We  shall  see,  in  the  chapter  on 
Developmental  Neuroses,  that  there  is  a  tendency  to  produce 
atavism,  or  a  return  to  the  negro,  Mongolian,  or  Indo- 
European  types,  and  also  that  deformities  of  the  nose,  face, 
jaws  and  teeth  result. 


CHAPTER  VI. 

DEVELOPMENT  OF  THE  JAWS. 

The  author  does  not  consider  it  necessary  in  this  chapter 
to  enter  into  the  details  of  the  embryonic  development  of  the 
jaws  for  two  reasons.  First,  he  can  add  nothino^  to  what  has 
already  been  written  upon  this  subject,  and,  second,  he  does 
not  believe,  from  an  experience  of  twenty  years'  study,  that 
the  causes  which  produce  constitutional  deformities  of  the 
jaw  antedate  the  sixth  year  of  the  individual,  except  in  the 
part  which  heredity  controls. 

It  is  a  well-known  fact  that  those  nations  or  races  which 
do  not  intermarry  rarely,  if  ever,  have  irregularities  or 
deformities.  This  illustrates  w^ell  the  advantage  of  marriage 
within  the  same  type.  Irregularities  of  the  teeth  and  jaws 
are  seldom  found  among  pure  Africans,  Chinese,  Italians  and 
Jews;  but  in  those  countries  where  all  nations  of  the  world 
congregate  and  intermarry,  irregularities  of  the  jaws  and  teeth 
must  necessarily  follow. 

A  good  illustration  of  this  mixture  of  races  is  found  among 
the  people  inhabiting  the  borders  of  different  countries.  Far- 
rar  says:  "The  women  of  Albania,  and  tho&e  of  Biscay  and 
Galicia,  who,  from  religious  scruples  and  national  prejudice 
decline  to  intermarry  with  their  neighbors,  are  much  more 
beautiful  than  those  of  Piedmont  or  Fruili." 

In  the  Puritans  of  New  England  the  jaws  were  in  propor- 
tion to  the  remainder  of  the  body,  but  after  foreign  nations 
began  to  pour  into  America  and  intermarriage  to  take  place, 
very  little  of  the  Puritan  stock  remained,  and  the  jaws  and 
teeth  became  degenerated  in  their  development. 

The  largest  normal  jaws  are  found  among  a  few  African 
races,  and  the  smallest  among  the  Bushmen,  Hottentots  and 
the  people  who  inhabit  the  mountainous  plateaus  between 
Spain  and  Portugal. 

Mr.  John  R.  Mummery,  in  a  paper  before  the  Odontolog- 
ical  Society  of  Great  Britain,  gives  as  the  result  of  the  exam- 

55 


56  ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 

ination  of  3,000  skulls  of  modern  and  ancient  races,  that  the 
average  width  of  the  arch  between  the  first  molars  in  ancient 
races  was  about  2f  inches,  and  modern  uncivilized  races  2^ 
inches,  while  the  greatest  diameter  was  2|  inches. 

I  cannot  do  better  at  this  point  than  to  quote  from  my  work 
on  ''  Degeneracy  of  the  Jaws  and  Teeth  of  the  Human  Race'": 

"Evolutionists  and  scientists  have  frequently  mentioned 
the  fact  that  the  jaws  are  changing  in  shape  and  size,  but  they 
have  never  produced  data  to  show  just  what  changes  have 
taken  place.  I  have  therefore  collected  a  large  number  of 
measurements  for  the  purpose  of  obtaining  facts  in  regard  to 
these  changes.  The  measurements  of  the  skulls  of  the  early 
races,  as  Avell  as  modern  people,  were  made  from  specimens 
in  the  museums  and  crypts  of  churches  in  Europe,  where 
large  collections  of  skulls  have  been  placed.  In  many  of  the 
museums  the  skulls  have  been  classified  and  tabulated  in  such 
a  manner  that  an  examination  of  them  is  easily  made.  The 
large  Hunter  collection  of  skulls  at  the  College  of  Surgeons 
in  London  was  examined  by  the  late  Mr.  John  Mummery; 
Dr.  Betty,  of  Cincinnati,  examined  the  large  collection  of 
skulls  at  the  Smithsonian  Institution  in  Washington;  Dr.  C. 
N.  Peirce,  of  Philadelphia,  crania  in  the  Academy  of  Natural 
Sciences  of  that  city ;  Dr.  Schuhmann,  of  Chicago,  crania  in 
Rome,  Italy;  Dr.  Barrett,  of  Buffalo,  crania  in  his  private 
collection  and  in  the  Buffalo  Academy  of  Natural  Sciences; 
Dr.  Pratt,  crania  in  the  Academy  of  Natural  Sciences  of 
Davenport,  la. ;  and  I  have  made  examinations  of  many  skulls 
in  different  parts  of  Europe  and  also  of  the  collection  of  Peru- 
vian skulls  in  the  Michigan  University  at  Ann  Arbor  and 
the  Peabody  Museum,  Harvard  College. 

"Measurements  of  the  jaws  of  living  individuals  of  differ- 
ent countries  and  nationalities  have  been  taken  by  the  fol- 
lowing dentists,  as  well  as  by  myself:  Dr.  Caracatsanis, 
Athens,  Greece;  Drs.  Franz  Berggren  and  Elof  Forberg, 
Stockholm,  Sweden;  Dr.  A.  Scheller,  Warsaw,  Poland;  Dr. 
Johan  Kier,  Copenhagen,  Denmark;  Dr.  Sturpenick,  Brus- 
sels, Belgium;  Dr.  Ed.  Wagner,  North  China;  Drs.  Perkins 
and  Ivy,  Shanghai,  China;  Dr.  D.  D.  Bode,  India;  Dr.  A.W. 
Baker,   Dublin,   Ireland;  Drs.  W.    Barrett  and  Wm.   Hern, 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


57 


London,  England;  Dr.  I.  N.  Demorest,  Santiago,  Chile;  Dr. 
Geo.  Warren,  Philadelphia,  Pa. ;  Dr.  R.  B.  Winder,  Balti- 
more, Md.;  Dr.  S.  D.  Hodge,  Burlington,  Vt.;  Dr.  W.  E. 
Page,  Boston,  Mass. ;  Dr.  C.  Sill,  New  York,  N.  Y. ;  Drs. 
Geo.  Crisup,  Ira  Cressiman,  Volini  and  V.  D'Elia,  Chicago, 
111.  I  wish  at  this  point  to  thank  those  gentlemen  who  so 
kindly  assisted  me  in  the  very  laborious  work  of  obtaining 
these  measurements,  thus  contributing  their  part  to  the  pro- 
gress of  science.  The  people  whose  mouths  have  been  exam- 
ined comprise  individuals  in  the  different  walks  of  life,  a  part 
of  them  composing  the  patients  of  practitioners  of  dentistry 


and  constituting  the  better  classes,  while  others  are  dispens- 
ary patients  and  from  the  middle  and  poorer  classes. 

"The  measurement  was  made  across  the  upper  jaw,  from 
the  outer  surface  of  one  first  molar  to  the  outer  surface  of 
the  corresponding  molar  of  the  other  side  (Fig.  9).  These 
points  were  taken  because  these  molars  are  the  first  teeth  of 
the  permanent  set  to  develop,  and  from  the  fact  that,  devel- 
oping posterior  to  the  temporary  ones,  they  erupt  independ- 
ently of  and  are  not  interfered  with  by  any  of  the  other  teeth 
which  are  in  the  jaw.  The  point  of  the  jaw  where  these  teeth 
are  situated  is  the  widest  part  that  is  normally  developed  and 
is  not  influenced  by  local  causes;  therefore  this  position  was 
the  most  accessible  for  the  object  required.  The  measure- 
ments were  made  in  the  mouths  of  persons  over  twenty-five 


58 


ETIOLOGY   OF  OSSEOUS  DEFORMITIES  OF 


years  of  age,  irrespectiv^e  of  the  exact  age,  for  the  reason  that 
at  this  period,  or  nearly  at  this  period,  the  individual  has 
completed  his  growth.  After  this  period  the  development  of 
the  skeleton  is  very  slow,  and  at  the  age  of  thirty  to  thirty- 
five  ceases  altogether. 

"In  securing  this  large  collection  of  measurements  of  crania 
and  living  individuals,  the  compilation  of  which  has  extended 
over  a  period  of  eight  years,  I  have  endeavored  to  show  by 
actual  demonstration  that  the  jaw  of  the  human  race  is  dim- 
inishing in  size. 

"The  following  is  the  table  of  measurements: 

EXAMINATION    OF    THE    CRANIA 

Of  Modern  Races  and  Ancient  Races  in  the  Hunterian  Museum  by  Dr.  Mum- 
mery.    Also  crania  in  the  Oxford  University  Museum,  and 
in  a  number  of    private   collections. 


No. 

LATERAL  DIAMETER. 

MODERN  RACES. 

MINIMUM. 

maximum. 

AVERAGE. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

Esquimaux 

69 
56 

2.375 
2.375 

60.32 
60.32 

2.750 
2  750 

69.85 
69.85 

2.562 
2.562 

65  07 

N.  Americans  (Coast) 

65.07 

N.  Americans  (Interior) 

23 

2.375 

60.32 

2.625 

66.68 

2.. 500 

63 .  .50 

S.  Americans  (Chile) 

19 

2  500 

63.50 

2.750 

69.85 

2.625 

66.67 

Fiji  Islanders 

38 
79 

2.500 
2.375 

63.50 
60.32 

2.875 
2.625 

73.02 
66.68 

2.687 
2.500 

68 .  26 

Polynesians  (Various) 

63 .  50 

Sandwich  Islanders 

21 

2.375 

60.32 

2.625 

66.68 

2.500 

63 .  50 

New  Zealanders 

67 

2.. 500 

63.. 50 

2.875 

73.02 

2.687 

68.26 

Australians 

132 
33 
24 

27 
152 

2.375 
2.375 
2.375 
2.2.50 
2.2.50 

60.32 
60.32 
60.32 
57.14 
57.14 

2.7.50 
2.625 
2.750 
2.625 
2.750 

69.85 
66.68 
69.85 
66.68 
69.85 

2.562 
2.. 500 
2.562 
2.437 
2.500 

65.07 

Tasm  anians 

63 .  .50 

Malays 

65 .  07 

Chinese 

61.91 

East  Indians  (North) 

63.49 

East  Indians  (South) 

71 

2.125 

53.97 

2.. 500 

63.50 

2.312 

58.73 

Africans  (East) 

33 

2.125 

53.97 

2.7.50 

69.85 

2.437 

61.91 

Caffres 

49 
29 

2.375 
2.125 

60.32 
53.97 

2.875 
2.375 

73.02 
60.32 

2.625 
2.2.50 

66 .  67 

Bosjesmen  and   Hottentots 

57   14 

Africans   (West) 

236 
92 

68 

2.2.50 
2.. 500 

2.125 

57.14 
63.50 

53.97 

2.7.50 
2.875 

2.625 

69.85 
73.02 

66.68 

2.500 
2.687 

2.375 

63 .  50 

ASHANTEES.  .  .  . 

68 .  26 

Ancient  Britons  (Dolicho-  } 
cephalic) ^ 

Ancient  Britons  (Brachy-  } 
cephalic) f 

60.32. 

32 

2.125 

53.97 

2.. 500 

63.. 50 

2.312 

58.73 

Ancient    Britons   (Canon  / 
Greenwell's   Explorations)  f 

Ancient  Britons  (Miscel-  ) 
laneous) \ 

Romano-Britons 

59 

44 
143 

2.125 

2.125 
2.125 

.53.97 

53.97 
53.97 

2.. 500 

2.. 500 
2.625 

63.. 50 

63.50 
66.68 

2.312 

2.312 
2.375 

58 .  73 

58 .  73 
60.. 32 

Anglo-Saxons 

76 
36 

2.2.50 
2.125 

57.14 
53.97 

2.625 
2.625 

66.68 
66.  ()8 

2.437 
2.375 

61.91 

Ancient    Egyptians . . 

60.32 

THE    HEAD,    FACE,    JAWS   AND   TEETH 


nu 


In 


EXAMINATION    OF   CRANIA 

Peabody  Museum,  Harvard  University;  Academy  of  Natural  Sciences, 
Philadelphia;  Davenport  Academy,  Army  Museum;  Roman,  French,  and 
English  Crania  in  European  museums,  and  private  collection  of  Barrett. 
Miscellaneous  crania  by  Drs.  Peirce,  Newton,  Schuhmann,  Barrett,  Pratt, 
Betty,  and  Talbot. 


No. 

Sex 

LATERAL  DIAMETER. 

RACE. 

MINIMUM. 

MAXIMUM. 

ayebage. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

Europeans  —  Ancient  and  ( 

37(5 

? 

1.94 

49.19 

2.69 

68.26 

2  34 

58.84 

Modern  Romans,  Italians,  -j 
French,  English ( 

36 

M 

2.06 

52.32 

2.37 

60.  .30 

2.20 

55.95 

30 

F 

1.88 

47.62 

2.44 

61.90 

2.08 

52.81 

26 

M 

2.13 

53.95 

2.  .50 

63.. 50 

2.29 

58.17 

Sandwich  Islanders.  . . .  ■{ 

26 

F 

2.06 

52.32 

2.37 

60. 30 

2.20 

55.95 

i 

8 

? 

o  oo 

56.35 

2.. 50 

63.50 

2.. 30 

58.45 

\ 

137 

M 

2.00 

50.80 

2.63 

66.67 

2.30 

58.45 

Ancient  Peruvians - 

124 

F 

1.88 

47.62 

2.56 

65.08 

O    O  0 

56.34 

( 

117 

? 

2.00 

50.80 

2  56 

65.08 

2.30 

58.45 

Ancient      Californians, 

from  Santa  Cruz  Islands, 
Coast  of  California;  Santa  <J 
Catalina    Island,    Brazil;  | 

34 

38 

M 
F 

2.06 
2.06 

52.32 
52.32 

2.63 
2.44 

66.67 
61.90 

2.31 
2.25 

58.84 
57.14 

Nicaragua,   St.  Miguel..  [ 

Mexicans 

27 
29 
26 

? 

M 
F 

1.94 
2.06 
2.06 

49.19 
52.32 
52.32 

2.. 50 
2.50 
2.37 

63.50 
63.50 
60.30 

2.31 
2.31 
2.22 

58.84 

Californian  Indians i 

58.84 
56.34 

Mound  Builders,  Mounds  i 

56 

M 

2.06 

52.32 

2.63 

66.67 

2.33 

59.48 

in  Kentucky  and  Tennes-  -| 

47 

F 

2.00 

.50.80 

2.. 50 

63.50 

2.28 

57.92 

see ( 

.57 

? 

2.06 

52.32 

2.69 

68.26 

2.39 

60.70 

Stone     Grave      People,  f 

Cumberland  Valley,  Ten-  | 

87 

M 

2.13 

53.95 

2.69 

68.26 

2.42 

61.90 

nessee;Illinois  River, Indi-  •{ 

89 

F 

1.88 

47.62 

2.50 

63.50 

2.28 

57.92 

ana;  Arkansas,   Michigan  | 

11 

? 

2.13 

53.95 

2.44 

61.90 

2.28 

57.92 

and  various  places [ 

Indians — North  American.  1 
Different  Tribes 1 

17 

11 

191 

M 
F 
? 

2.13 
2.13 

1.88 

53  95 
53.95 
47.62 

2.. 50 
2.31 
2.63 

63.50 

58.84 
66.67 

2.30 
2.23 
2.31 

58.45 
56.69 

58.84 

Negro — Rio  de  Favino 

1 

2.19 

55.56 

2.19 

55.56 

2.19 

55.56 

Flat  Heads  from  Oregon,  ( 

3 

M 

2.2.5 

57.13 

2.50 

63.. 50 

2.45 

62.31 

Washington,     Gulf     of  -| 

o 

F 

2.13 

53.95 

2.44 

61.90 

2.28 

57.92 

Georgia,  Peru ( 

18 

? 

2.25 

57.13 

2.75 

69.85 

2.53 

64.29 

Crania  from   San  Lorenzo  j 

4 

M 

2.25 

57.13 

2.37 

60.30 

2.30 

58.45 

Cave,  Mexico ( 

3 

F 

2.13 

53.95 

2.37 

60.30 

2.20 

55.95 

Crania  from  Caves  in  Ten-  \ 

4 
9 
3 

M 

2.13 

53.95 

2.19 

55.56 

2.14 
2.23 
2.19 

54.38 
56.69 
55.56 

nessee,  Kentucky,  Mexico-  1 

F 

2.06 

52.32 

2.25 

57.13 

Esquimaux  from  Labrador,  \ 

40 

? 

1.75 

44.46 

2.63 

66.67 

2.23 

56.69 

Norton  Sound \ 

2 
1 

M 

M 

2.25 
2.13 

57.13 
53.95 

2  31 
2.13 

58.84 
53.95 

2.28 
2.13 

57.92 

53.95 

Hindoos - 

1 
3 

? 
F 

2.22 
2.06 

56.35 
52-32 

2  37 

56  35 
60.30 

2.25 

5  (3 . 3  5 

57.14 

Herney  Islanders -] 

3 

1 

M 
? 

2.19 
2.13 

55.56 
53.95 

2.50 
2.13 

63.50 
53.95 

2.33 
2.13 

59.13 
53.95 

Hawaiian  Islander 

1 

M 

2.31 

58.84 

2.31 

58.84 

2.31 

58.84 

60 


ETIOLOGY   OF   OSSEOUS   DEFORMITIES  OF 


EXAMINATION    OF     CRANIA — CONTINUED, 

In  Peabody  Museum,  Harvard  University;  Academy  of  Natural  Sciences, 
Philadelphia;  Davenport  Academy;  Army  Museum;  Roman,  French,  and 
English  Crania  in  European  museums,  and  private  collection  of  Barrett. 
Miscellaneous  crania  by  Drs.  Peirce,  Newton,  Schuhmann,  Barrett,  Pratt, 
Betty,   and  Talbot. 


No.   S] 

:x 

LATERAL  DIAMETER. 

RACE. 

MINIMUM. 

MAXIMtTM. 

AVEEAGE. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

( 

2       J 

A 

3.13 

53.95 

3.. 50 

63.50 

2.31 

58.84 

Negroes,  African  Negroes.  - 

79 

? 

1.88 

47.63 

3.47 

63  70 

.57.58 

1 

1       ] 

F 

3.2.5 

57.13 

3.35 

57.13 

3  35 

57.13 

Zulus,  South  Africa -j 

1       ] 

1       J 

d 

2. 35 
3.44 

57.13 
61.90 

3.3.5 
3  44 

57.13 
61.90 

3.35 
3.44 

57.13 
61.90 

Probably  Africans 

3       1 

F 

3.00 

50.80 

3.35 

57.13 

2.13 

53.95 

Negro  Giles,  executed  at  } 
Richmond,    Va ) 

1      J 

A 

3.31 

58.84 

2.31 

58.84 

3.31 

.58.84 

Aleutian  Islander 

1       ] 

F 

3.13 

53.95 

2.13 

53.95 

3.13 

53.95 

GUANCHE  

1       ] 
1       ] 

3.0(3 
3.19 

53.33 
55.56 

3.06 
3.19 

53.33 
.55.56 

3.06 
3.19 

52.32 

Pegu,  Burmah 

55.56 

Mauritian  Dwarf.    .    . 

1 

3     r 

5       ] 

? 
A. 

3.19 
3.31 

1.88 

55.56 

58.84 
47.63 

3.19 
2.44 
3.31 

55.. 56 
61.90 

58.84 

3.19 
3.37 
3.13 

55  56 

Unknown ■] 

60.30 
53.95 

Fiji  Islanders 

o 

1 

3.31 
3.37 

58.84 
60.30 

3.44 
2.37 

61.90 
60.30 

2.37 
3.37 

60.30 

Loo  Choo  Islander 

60.30 

Burmese 

1 

4 

3.47 

3.28 

63.70 
57.93 

3.47 
3.44 

63.70 
61.90 

2.47 
2.36 

62.70 

Marquesas  Islanders 

.59.91 

Assiniboin 

3 
.5 
13 
o 
o 
2 

? 

2.38 
3.16 
3.16 
3.3.5 
3.33 
3.37 

57.93 
54.75 
.54.75 
57.13 
56.35 
60.30 

3.37 
3.31 
3.53 
2.47 
2.34 
2.50 

60.30 
58.84 
64.39 
63.70 
59.57 
63.. 50 

2.31 
2.25 
3.37 
3.36 

3.38 
3.44 

58.84 

Kankakee 

57.14 

Malay 

60.30 

Tahitian 

59.91 

Ta TLIT  KOOCHIN 

57.92 

Laplanders 

61.90 

Japanese  

1 
2 

10 

3.37 
1.97 
3.09 

60.30 
50.07 
53.13 

2.37 
2.00 
2.69 

60.30 
.50.80 
68.36 

3.37 
1.98 
3.31 

60.30 

Parsee  

50.40 

Australians 

58.84 

Armenians 

4 
1 

18    ? 

3.00 
3.35 

1.88 

50.80 
57.13 

47.63 

3.09 
3.35 

3.50 

53.13 
57.13 

63.. 50 

3.06 
3.35 

3.30 

53.39 

Samoan  Islander 

57.13 

Ancient  Egyptian  (Egyp-  } 
tian  Type) f 

55.95 

Ancient   Egyptian  (Neg- 
roid Type) 

11 

3.13 

53.95 

3.69 

68.26 

3.37 

60.30 

Copt 

1 
3 

3.13 

1.88 

53.95 
47.63 

2.13 
2.13 

53.95 
53.95 

3.13 
2.01 

53.95 

Egyptian  Negroes 

51.05 

Ancient  Egyptians 

37 

1.88 

47.63 

3.33 

56.35 

3.06 

53.59 

Arab 

o 

1 

3.19 
3.19 

55.56 
55.56 

3.31 
3.19 

58.84 
55.56 

3.35 
3.19 

57.14 

Choctaw  and  Negro 

.55.56 

Hispano-Peruvian 

2 
1 
1 

? 

3.13 
3.56 
3.. 50 

53.95 
65.08 
63.. 50 

3.33 
3.56 
2.. 50 

56.35 
65.08 
63.. 50 

3.17 
3.56 
3.50 

55.16 

Dutch  

65.08 

Anglo-American 

63.. 50 

Recent  Crania,  Pa.  (?).... 

22 

? 

1.97 

.50.07 

2.. 50 

63.50 

3.30 

58.45 

Total 

1840 

1.88 

47.63 

3.69 

68.36 

2.28 

57.94 

THE    HEAD,    FACE,    JAWS   AND   TEETH 


61 


'   EXAMINATION    OF   THE    MOUTH. 

Of  Living  Persons,  Showing  Measurement  of  the  Superior  Maxilla. 


RACE. 


Residents     of     Athens, 
Greece 

Stockholm,  Sweden -j 

Copenhagen,  Denmark.    .  < 

Brussels,    Belgium < 

Warsaw,  Poland \ 

China 

Typical  People  of  India. .  -j 
Italians i 


Santiago,   Chile j 

London,  England K 

Dublin,  Ireland -j 

American-born  Negroes. .  -l 

Dispensary  patients  of  ( 
Philadelphia,  Baltimore  -' 
and  Boston ( 

Residents  of  Burlington,  \ 
Vermont \ 

Boston,    Mass 


New  York  City ■) 

Chicago  and  Illinois ■] 

Marshpee   Indians 


Total 8396 


No. 


15 

14 

393 

194 

350 

50 

148 

158 

150 

150 

73 

33 

46 

3 

666 

189 

106 

154 

303 

187 

86 

136 

138 

108 

463 
341 

53 

50 

896 

47 

56 

1696 

1116 

55 

6 


Sex 


M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 
M 
F 

M 
F 

M 

F 

ivi 

F 

M 
F 
M 
F 


LATERAL  DIAMETER. 


MINIMUM. 


In.      Mm. 


1.75 
1.75 
1.88 
1.75 
1.75 
1.75 
1.97 
1.75 
3.03 
1.94 
3.00 
3.00 
1.94 
1.94 
1.94 
1.88 
1.75 
1.75 
1.88 
1.88 
1.88 
1.88 
3.07 
1.97 


MAXIMUM. 


In.      Mm. 


1.97 
1.88 
1.94 
1.75 
1.75 
1.75 
1.75 
3.00 
3.07 

1.87 


44.46 
44.46 
47.63 
44.46 
44.46 
44.46 
50.03 
44.46 
51.30 
49.35 
50.80 
50.80 
49.35 
49.35 
49.35 
47.63 
44.46 
44.46 
47.63 
47.63 
47.63 
47.62 
53.50 
50.03 


1.88    47.63 
1.75    44.46 


50.03 
47.63 
49.25 
44.46 
44.46 
44.46 
44.46 
50.80 
53.50 

47.54 


2.13 
3.02 
3.63 
3.60 
3.56 
3.46 
3.56 
3.60 
3.60 
3.40 
3.44 
3.53 
2.37 
2.07 
3.63 
3.44 
3.40 
3.34 
3.63 
3.44 
3.63 
2.53 
3.52 
2.31 


53.95 
51.30 
66.67 
66.00 
65.00 
62.50 
65.00 
66.00 
66.00 
61.00 
62.00 
64.00 
60.30 
53.50 
66.67 
62.00 
61.00 
59.57 
66.67 
62.00 
66.67 
64.00 
64.00 
58.84 


In.     Mm. 


2.56    65.00 
3.63    66.67 


3.37 
3.30 
3.31 
2.52 
3.53 
3.53 
3.53 
3.53 
3.07 

3.41 


60.30 
56.00 
58.84 
64.00 
64.00 
64.00 
64.00 
64.00 
53.50 

63.08 


1.98 
1.90 
3.36 
3.15 
3.24 
3.18 
3.35 
2.18 
2.31 
3.17 
3.36 
3.19 
3.13 
3.00 
3.17 
3.00 
3.11 
2.04 
3.38 
3.09 
095 

3.11 
030 

3.20 

3.14 
2.01 

2.19 
2.03 
3.04 
3.18 
3.10 
2.13 
3.03 
3.34 
3.07 

3.14 


.50.40 
48.33 
57.37 
54.60 
56.83 
55.73 
57.05 
55.57 
58.84 
55.16 
57.37 
55.56 
53.95 
50.80 
55.16 
50.80 
53.57 
51.78 
57.92 
53.19 
57.13 
53.53 
58.98 
55.90 

54.33 
50.90 

55.56 
51.31 
51.80 
55.73 
53.36 
53.76 
51.31 
56.90 
53.. 50 

51.19 


62 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


EXAMINATION    OF   THE    CRANIA. 

In  Peabody  Museum,  Harvard  University;  Academy  of  Natural  Sciences, 
Philadelphia;  Davenport  Academy,  Army  Museum;  Roman,  French,  and 
English  Crania  in  European  museums,  and  private  collection  of  Barrett. 
Miscellaneous  crania  by  Drs.  Peirce.  Newton,  Schuhmann.  Barrett,  Pratt. 
Betty,  and  Talbot. 


No. 

Sex 

ANTERO-POSTERIOR  DIAMETER. 

RACE. 

MINIMUM, 

maximum. 

aveeage. 

In, 

Mm. 

In, 

Mm. 

In, 

Mm, 

Eltropeans  —  Ancient  and  f 

Modern    Romans,    Lake  J 

.31 

M 

1.69 

43.86 

3.00 

.50.80 

1.86 

47,33 

Dwellers,  French  prior  to  | 

.30 

F 

1.56 

39.69 

3.06 

53.32 

1.83 

46.43 

nineteenth  century I 

Sandwich  Islanders - 

26 
39 

M 
F 

1.63 
1.63 

41.38 
41.38 

2.19 
2.03 

55.56 
51.56 

1.91 
1.83 

48.38 
46.43 

( 

123 

M 

1.56 

39.69 

2.13 

53.95 

1.88 

47.62 

Ancient  Peruvians ■{ 

104 

F 

1.56 

39.69 

3.13 

53.95 

1.79 

45.64 

I 

2 

? 

1.69 

43.86 

1.94 

49.14 

1.84 

46.83 

( 

26 

M 

1.63 

41.38 

3.13 

53.95 

1.89 

48.03 

Ancient  Californians.  . .  -I 

33 

130 

32 

30 

F 

? 

M 
F 

1.69 

43.86 

3.06 

53.33 

1.86 
1.83 
1.91 
1.83 

47,23 
46,40 

Californian  Indians - 

1.69 
1.69 

42.86 
43.86 

3.13 
3.00 

53.95 
50.80 

48  38 
46.43 

I 

1.57 

M 

1.56 

39.69 

3.31 

58.69 

3.00 

.50.80 

Mound  Builders - 

83 

F 

1.63 

41.38 

3.13 

53.95 

1.89 

48  02 

1 

1 

? 

3.00 

.50.80 

3.00 

.50.80 

3.00 

,50,80 

Stone  Grave    People — \ 
Cumberland  Valley j 

83 
80 

7 

M 
F 

? 

1,63 
1,63 

1.88 

41,38 
41.28 
47.62 

3.35 
3.06 
3.00 

57,03 
53.32 
50.80 

1.97 
1.91 
1  94 

.50.00 
48.41 
49.21 

( 

110 

M 

1,75 

44,46 

3.31 

58.69 

1.99 

50.55 

Indians - 

.58 

F 

1.38 

35.09 

2.31 

58.69 

1  87 

47.44 

l 

3 

? 

1,81 

46.04 

2,00 

,50.80 

1.91 

48.38 

Negro — Rio  de  Favino.  ,  , .  . 

1 

9 

3.06 

53.33 

2,06 

52.33 

3.06 

52.32 

Flat  Heads  from  Oregon,  i 

3 

M 

1.88 

47.63 

2.35 

57.13 

3.00 

50.80 

Washington,     Gulf    of  -| 

o 

f 

1.88 

47.63 

3.00 

.50.80 

1.94 

49.21 

Georgio,  Peru ( 

1 

4 

? 
M 

3.00 
1.69 

.50.80 
42.86 

3.00 
2.00 

50.80 
50.80 

2.00 
1.83 

50.80 

Crania  from    San   Lorenzo  \ 

46.43 

Cave,  Mexico ( 

3 

4 

F 
M 

1.75 
1.69 

44.46 
42.86 

1.94 
1.88 

49.14 
47.63 

1.83 
1.79 

46.43 

CkANiA   from    Caves    in  ( 

45.64 

Tennessee,  Kentucky,  -| 
Mexico ( 

3 

? 
F 

1.75 

44.46 

2.00 

,50.80 

1.83 

46.43 

Esquimaux  from  Labrador,  j 
Norton  Sound ( 

7 
4 

? 

M 
M 

1.69 
1.69 

42.86 
42.86 

2.13 
2.00 

53.95 
50.80 

1.72 
1.69 

43.65 

\ 

42.86 

Hindoos -l 

■? 

o 

F 

1.81 

46.04 

1.81 

46.04 

1.81 

46.04 

Herney  Islanders ■] 

3 

M 
■? 

1.88 

47.62 

3,00 

50.80 

1.92 

48,81 

Hawaiian  Islander 

1 

M 

3.00 

.50.80 

2,00 

50.80 

2.00 

50.80 

( 

o 

M 

3.06 

53.33 

2,13 

53.95 

2.09 

53.18 

Negroes,  African  Negroes.  - 

? 
F 

THE  HEAD,  FACE,  JAWS  AND  TEETH 


63 


EXAMINATION    OF    THE    CRANIA — CONTINUED. 

In  Peabody  Museum,  Harvard  University;  Academy  of  Natural  Sciences. 
Philadelphia;  Davenport  Academy,  Army  Museum;  Roman,  French,  and 
English  Crania  in  European  museums,  and  private  collection  of  Barrett. 
Miscellaneous  crania  by  Drs.  Peirce,  Newton,  Schuhmann,  Barrett,  Pratt. 
Betty,  and  Talbot. 


No. 

Sex 

ANTERO-POSTERIOR  DIAMETER. 

RACE. 

MINIMtnVI. 

maximum. 

avebage. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

Zulus,  South  Africa  . . . 

■■{ 

1 
1 

F 

M 

1.94 
2.00 

49.14 
50.80 

1.94 
2.00 

49.14 
50.80 

1.94 
2.00 

49.14 
50.80 

Probably  Africans.  . . 

at  } 

1 

F 
M 

Negro  Giles,  executed 
Richmond,   Va 

2.19 

55.56 

2.19 

55.56 

3.19 

55.56 

Aleutian  Islander.  . . 

1 
1 
1 
1 
3 
5 

F 
F 

F 

? 

M 
F 

2.13 
1.63 
1.88 
2.13 
1.81 
1.69 

53.95 
41.28 
47.62 
53.95 
46.04 
42.86 

2.13 
1.63 
1.88 
2.13 
2.06 
2.00 

53.95 
41.28 
47.62 
53.95 
52.33 
50.80 

2.13 
1.63 
1.88 
2.13 
1.95 
1.91 

53.95 

GUANCHE  

41.28 

Pegu,  Burmah 

47.62 

Mauritian  Dwarf,  ...    -  - 

53.98 

Unknown 

49.60 
48.41 

Fiji  Islanders 

1 
1 

M 
F 

2.28 
2.09 

57.92 
53.19 

2.28 
2.09 

57.92 
53.19 

2.28 
2.09 

57.92 
53  19 

Bavarian 

1 

M 

2.13 

53.95 

2.13 

53.95 

2.13 

53.95 

1 

F 

1.81 

46.04 

1.81 

46.04 

1.81 

46.04 

New  Zealanders 

3 
3 

M 
F 

1.56 
1.75 

39.69 
44.46 

2.13 
2.03 

53.95 
51.56 

1.92 
1.93 

48.76 
49.00 

Austrians 

3 

M 

1.94 

49.25 

2.01 

51.05 

1.96 

49.78 

3 

F 

1.75 

44.46 

2.13 

53.95 

1.94 

49.25 

Chinese 

1 

M 

2.09 

53.19 

2.09 

53.19 

2.09 

53.19 

1 

b' 

1.94 

49.25 

1.94 

49.25 

1.94 

49.25 

Japanese 

1 
1 

M 
F 

1.91 
2.06 

48.23 
52.32 

1.91 
2.06 

48.23 
52.32 

1.91 
2.06 

48.23 

52.32 

Australians 

1 
o 

M 
F 

2.25 
1.75 

57.13 
44.46 

2.25 

2.28 

57.13 
57.92 

2.25 
2.01 

57.13 
51.05 

Samoan  Islander  .... 

1 
1 

1 

M 
M 
F 

1.94 
2.00 
1.88 

49.25 
50.80 
47.62 

1.94 
2.00 
1.88 

49.25 
50.80 
47.63 

1.94 
2.00 
1.88 

49.35 

Gallo-Roman 

-1 

50.80 
47.62 

Romano-British 

1 
3 
1 

F 
M 
F 

1.84 
1.75 
2.19 

46.74 
44  46 
55.56 

1.84 
2.13 
2.19 

46.74 
53.95 
55.56 

1.84 
1.98 
2.19 

46  74 

Whites 

..  ] 

50.29 
55.56 

Egyptian 

1 
3 
3 

F 
M 
F 

1.81 
2.03 
2.06 

46.04 
51.56 
52.32 

1.81 
2.19 
2.13 

46.04 
55.56 
53.95 

1.81 
2.13 
2.08 

46.04 

American  Negroes.  . 

53.95 
52.73 

Marshpee  Indians.  . . . 

34 
712 

1.75 
1.56 

44.46 
39.69 

2.07 
2.19 

53.29 
55.56 

1.98 
1.84 

50  27 

Patients    and    Friends 
Author 

of  1 

46.74 

Total 

3015 

1.66 

45.84 

2.04 

51.42 

1.78 

49.33 

64 


ETIOLOGY   OF   OSSEOUS  DEFORMITIES  OF 


EXAMINATION    OF    THE    CRANIA — CONTINUED. 


RACE. 


Europeans — Ancient  and  ^ 
Modern  Romans;  Lake  ( 
Dwellers;  French  prior  to  j 
nineteenth  century J 

Sandwich  Islanders  . . . .  \ 


Ancient  Peruvians. 


Ancient  Californians.  . .  -j 
Californian  Indians.  . . .  \ 


Mound  Builders. 


Stone   Grave    People  —  \ 
Cumberland  Valley ') 


Indians 


Negro — Rio  de  Favino 

Flat  Heads  from  Oregon,  ( 
Washington,  Gulf  of  J^ 
Georgia,  Peru ( 

Crania  from  San  Lorenzo 
Cave,  Mexico 

Crania  from  Caves  in 
Tennessee,  Kentucky, 
Mexico 

Esquimaux  from  Labrador, 
Norton  Sound 


Hindoos 

Herney  Islanders  . . 
Hawaiian  Islander. 


Negroes,  African  Negroes. 
Zulus,  South  Africa 


No. 


26 

1.37 

124 

17 

34 

38 

29 

20 

5(5 

47 

7 

87 

89 

11 

17 

11 

3 

1 

3 

o 

1 
4 
3 
3 


Sex 


HEIGHT  OF  VAULT. 


MINIMUM. 


In.      Mm. 


.31 

.37 
.31 
.2.5 
.37 
.44 
.44 
.44 
.41 
.44 
.44 
.44 
.41 
.41 
.37 
.37 
.44 
.41 
..50 


.50 
..50 
..50 
.50 
.44 
.53 


.47 


..50 
..50 


.44 
.44 


.63 
.53 


.44 
..50 

.75 


0.35 
7.(55 

9.39 

7.62 

6.35 

9.39 

11.17 

11.17 

11.17 

10.45 

11.17 

11.17 

11.17 

10.45 

10.45 

9.39 

9.39 

11.17 

10.45 

12.70 


12.70 
12.70 
12.70 
12.70 
11.17 
13.46 


11.93 


12.70 
12.70 


11.17 
11.17 


10.00 
13.46 


11.17 
12.70 
19.05 


In.      Mm. 


.69 
.63 

.75 
.09 
.81 
.75 
.63 
.69 
.75 
.69 
.69 
.72 
.69 
.66 
.88 
.75 
..56 
.69 
..59 
.63 


.75 
..56 
.50 
.69 
.66 
.53 


.53 


.56 
.50 


.69 
.63 


.03 
.63 


.44 
.50 
.75 


17.52 
10.00 

19.05 
17.52 
20.57 
19.05 
16.00 
17.52 
19.05 
17.52 
17.52 
18.29 
17.52 
16.78 
22.35 
19.05 
14.23 
17.52 
14.98 
16.00 


19.05 
14.23 
12.70 
17.52 
16.78 
13.46 


13.46 


14.23 
12.70 


17.52 
16.00 


16.00 
16.00 


11.17 
12.70 
19.05 


AVEBA6E. 


In.     Mm. 


.53 

.48 

.55 
.52 
.57 
.57 
.49 
.55 
.55 
.54 
.52 
.55 
.56 
.51 
.60 
.55 
..50 
.57 
.47 
.56 
..50 
.65 
.53 
.50 
.60 
..54 
.53 


.51 


.53 
.50 


.60 

.57 


.03 
.57 


.44 
..50 


13.46 
12.19 

13.97 
13.21 
14.47 
14.47 
12.45 
13.97 
13.97 
13.71 
13.21 
13.97 
14.23 
12.95 
15.02 
13.97 
12.70 
14.47 
11.93 
14.23 
12.70 
16.51 
13.46 
12.70 
15.02 
13.71 
13.46 


12.95 


13.46 
12.70 


15.02 
14.47 


16.00 
14.47 


11.17 
12.70 
19.05 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


C,o 


EXAMINATION    OF    THE    CRANIA — CONTINUED. 

In  Peabody  Museum,  Harvard  University;  Academy  of  Natural  Sciences, 
Philadelphia;  Davenport  Academy,  Army  Museum;  Roman,  French,  and 
English  Crania  in  European  museums,  and  Private  collection  of  Barrett. 
Miscellaneous  crania  by  Drs.  Peirce,  Newton,  Schuhmann,  Barrett,  Pratt, 
Betty,  and  Talbot.  m 


No. 

Sex 

HEIGHT  OP  VAULT. 

RACE. 

MINIMUM. 

MAXIMUM. 

AVEEAGE. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

Probably  Africans 

Negro  Giles,  executed  at  ) 

Richmond,  Va ^ 

Aleutian  Islander 

GtfANCHE 

Pegu,  Burmah . 

o 

1 

1 
1 
1 
1 

3 

.5 

46 

F 

M 

F 
F 

F 
? 

M 

F 

.44 

.50 

.31 
.44 
.50 
.50 
.53 
.53 
.41 

11.17 

12.70 

7.62 
11.17 
12.70 
12.^0 
13.46 
13.46 
10.45 

.50 

.50 

.31 
.44 
..50 
..50 
.56 
.69 
.63 

12.70 

12.70 

7.62 
11.17 
12.70 
12.70 
14.23 
17.52 
16.00 

.47 

.50 

.31 
.44 
.50 
.50 
.54 
.57 
.52 

11.93 

12.70 

7.62 
11.17 
12.70 

Mauritian  Dwarf 

Unknown ] 

Marshpee  Indians 

12.70 
13.71 

14.47 
13.22 

Total 

954 

.44 

11.36 

.62 

15.48 

.51 

13.57 

[The  averages  in  table  on  page  58  are  made  up  from  the 
maximum  and  minimum  figures  alone,  while  those  in  the 
other  tables  are  deduced  from  the  total  of  all  the  measure- 
ments. ] 

"  While  one  would  naturally  expect  to  find  discrepancies  in 
the  figures  in  a  work  like  this,  in  which  so  many  different 
individuals  have  been  engaged,  great  care  was  exercised  in 
selecting  gentlemen  (most  of  whom  are  personal  friends  of 
mine  and  well  known  in  the  profession)  who  possessed  skill 
and  who  had  also  attained  prominence  in  their  calling. 

"In  comparing  the  measurements  of  living  individuals 
with  thosaof  the  crania,  an  allowance  of  .06  of  an  inch  should 
be  made  for  thickness  of  the  mucous  membrane. 

"The  difference  in  the  number  of  measurements  of  the 
antero-posterior  and  the  lateral  diameter  is  due  to  the  fact 
that  in  many  cases  the  antero-posterior  diameter  was  taken 
from  the  first  and  second  molars  instead  of  from  the  third; 
it  was  necessary  to  reject  all  such  measurements. 

"We  must  therefore  look  upon  these  figures  as  being  nearly 


60  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

correct  in  each  individual  case,  l)ecause  the  work  is  positive 
in  its  nature,  and  the  figures  are  simply  a  matter  of  record  as 
presented  by  the  instrument. 

MOUTHS    OF   LIVING    PERSONS — LATERAL   DIAMETER, 

"A  careful  study  of  the  table  will  show  that  the  diameter 
of  the  jav^s  depends  to  a  great  extent  upon  the  size  of  the 
skeleton;  thus  a  small  person  will  possess  a  small  jaAV,  a 
large  person  a  large  jaw.  This,  however,  is  not  invariable. 
AVe  frequently  find  small  people  with^large  jaws,  like  the 
cretins  of  Switzerland,  and  large  people  with  small  jaws,  as 
is  frequently  observed  in  limestone  countries.  This  condi- 
tion is  also  frequently  due  to  excessive  or  arrested  develop- 
ment of  the  maxilli*.  We  notice  that  there  is  as  marked  a 
difference  between  the  size  of  the  jaws  of  the  male  and  female 
as  there  is  in  the  size  of  the  skeleton  of  the  two  sexes.  This 
difference  ranges  from  .0-2  to  .16  of  an  inch,  and  is  charac- 
teristic not  only  of  living  individuals,  but  it  was  also  observed 
in  the  measurements  of  the  crania  of  the  ancient  races. 

"We  also  note  that  the  lateral  diameter  of  the  jaws  of  liv- 
ing persons  in  the  old  country  is  greater,  with  the  exception 
of  the  Athenians,  than  it  is  in  this  country  at  the  present 
time,  and  the  jaws  of  the  native  Indian  races  of  this  country 
are  much  larger  than  the  jaws  of  the  white  people  at  the 
present  time.  The  jaws  of  the  people  in  older  parts  of  this 
country  are  smaller  than  the  jaws  of  people  in  the  newer 
parts,  as  illustrated  in  the  measurements  of  the  jaws  of  the 
residents  of  Boston  and  those  of  Chicago. 

"There  is  also  a  marked  difference  between  the  diameters 
of  the  jaws  of  dispensary  patients  and  poorer  patients,  and 
those  observed  in  private  practice  among  the  wealthier 
classes.  This  is  well  illustrated  in  the  measurements  of 
patients  by  Dr.  Cressiman  and  those  measured  by  the  author. 

"This  is  also  well  illustrated  in  measurements  by  the 
author  of  patients  in  the  oflSce  of  Dr.  Shepard,  of  Boston, 
and  those  made  by  Dr.  W.  E.  Page,  of  Boston;  Dr.  Winder, 
of  Baltimore,  and  Dr.  Warren,  of  Philadelphia,  who  made 
examinations  of  dispensary  patients.      A   very   interesting 


THE  HEAD,  FACE,  JAWS  AND  TEETH  67 

point  to  be  noticed  is  that  the  purer  and  more  clannish  the 
race,  the  smaller  the  range  in  the  figures  representing  the 
diameters  of  the  jaws. 

"Thus  we  see  in  the  measurements  of  the  jaws  of  the 
Chinese  the  range  is  only  from  3  to  2.44,  with  one  measure- 
ment at  2,52;  the  people  of  India,  1.94  to  2.37;  the  negro, 
2. 07  to  2. 50 ;  the  Marshpee  Indians,  2  to  2 .  50 ;  while  in  the  mixed 
races  the  range  is  from  1.50  to  2.75,  extending  over  a  much 
greater  latitude  than  in  the  pure  races.  Thus  in  the  Swedes 
we  notice  that  the  range  is  from  1.88  to  2.63;  in  Dublin  from 
1.88  to  2.50;  in  London  from  1.88  to  2.44;  while  the  range 
of  the  white  people  in  America  is  from  1.50  to  2.63.  This 
disparity  in  the  size  shows  that  in  mixed  races  and  those  of  a 
nervous  temperament  the  arrest  of  development  and  exces- 
sive development  of  the  jaws  are  very  common;  while  on  the 
other  hand,  in  those  races  whose  customs  have  been  the  same 
for  hundreds  of  years,  where  the  soil,  climate,  and  environ- 
ments have  been  unchanged,  who  have  intermarried  arnong 
themselves,  very  little  difference  in  the  size  of  the  jaws  is 
noticed.  There  is  also  a  difference  noticed  in  people  who  live 
at  different  heights  of  the  same  country,  as  in  Northern  and 
Southern  Italy,  and  in  different  parts  of  America. 

'"It  is  not  necessary  to  take  measurements  of  different 
nationalities  to  show  that  the  jaws  are  diminishing  in  size, 
but  simply  compare  the  measurements  of  the  jaws  of  the 
same  nationality  at  different  periods  of  its  history.  Thus  the 
early  Britons  possessed  jaws  which  measured  from  2.12  to 
2.62  in  their  lateral  diameters,  while  the  jaws  of  the  present 
English  people  measure  from  1.88  to  2.44  inches.  It  will  be 
noticed  that  the  minimum  diameter  has  decreased  more  than 
the  maximum.  Again,  by  comparing  the  ancient  Romans 
with  the  modern  Italians  of  Southern  Italy,  we  find  that  the 
jaws  of  the  early  Romans  measured  from  2.12  to  2.62.  while 
the  jaws  of  the  present  Southern  Italians  measure  only  1.94 
to  2.69. 

"  In  comparing  the  measurements  of  the  uncivilized  races 
with  those  of  the  civilized,  it  will  be  observed  that  the  jaws 
of  the  former  are  much  larger  than  those  of  the  latter.     In 


68  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

the  majority  of  cases  the  size  and  shape  of  the  jaw  are  com- 
mensurate with  the  osseous  structure  of  the  individual.  The 
Bosjesraen  and  Hottentots  present  the  smallest  range  in  the 
size  of  the  jaw,  2.12  to  2.37  inches.  As  is  well  known,  they 
are  the  most  inferior  of  races  (with  the  exception  of  the 
Australians),  mentally  and  physically.  They  are  nomadic  in 
habit,  and  are  often  driven  from  place  to  place  by  stronger 
tribes.  Their  food  often  consists  for  some  time  of  herbs, 
roots,  berries,  plantain,  etc.  The  meat  consists  chiefly  of 
rats,  dogs,  etc.,  and  they  are  obliged  sometimes  to  feed  upon 
locusts,  ants,  lizards,  and  frogs.  This  mode  of  life  is  as 
artificial  in  one  direction  as  is  the  life  of  the  present  highly 
civilized  races  in  the  opposite  direction.  The  people  dwell 
along  the  banks  of  rivers,  near  marshes,  where  hygienic  sur- 
roundings are  wanting. 

"The  Chinese  live  under  artificial  conditions  also,  and  the 
size  of  their  jaws  range  from  2.25  to  2.62  inches.  Of  the 
East  Indians,  those  living  in  the  north  are  of  tall  stature  and 
well  developed.  They  live  on  the  high  plateaus,  while  those 
in  the  south  live  in  valleys.  The  physical  development  of 
the  latter  is  less,  and  their  maxillse  are  smaller  than  the 
former. 

"The  Esquimaux  are  of  short  stature,  but  of  remarkably 
well-developed  physique.  Their  maxillte  are  large  in  pro- 
portion to  the  osseous  development. 

"  The  Australians  are  the  lowest  types  of  mankind,  and 
their  jaws  range  from  2.37  to  2.75  inches.  The  jaws  are  very 
large  in  proportion  to  the  size  of  the  cranium.  The  Fiji 
Islanders  and  the  New  Zealanders  are  among  the  best  devel- 
oped, physically,  of  any  of  the  races,  past  or  present.  Their 
jaws  are  large,  ranging  from  2.50  to  2.75  inches.  Very  few 
cases  of  caries  were  found  by  Dr.  Mummery.  The  Poly- 
nesians and  Sandwich  Islanders  are  slightly  inferior  to  the 
former,  and  we  find  this  inferiority  marked  in  the  jaws  also. 

"  The  South  Americans  from  Chile,  occupying  the  western 
side  of  the  Andes,  are  descended  from  Spanish  and  Indian 
ancestors.  Their  teeth  are  very  large.  The  North  Ameri- 
can Indians  present  very  large  jaws.     They  are  well  devel- 


THE    HEAD,    FACE,    JAWS   AND   TEETH  69 

oped  physically  also.  Among  tho  ancient  Britons  we  would 
expect  to  find  that  the  dolichocephalic  raaxillie  were  nar- 
rower in  proportion  to  the  length,  and  the  brachycephalic 
maxillse  broader.  The  length  of  the  maxilise  has  not  been 
given,  consequentl}-  ihe  relative  proportion  of  length  and 
breadth  cannot  be  determined,  but  we  notice  that  the  maxi- 
mum brachycephalic  jaw  is  2.50  inches,  while  that  of  the 
dolichocephalic  is  2. 75  inches.  The  brachycephalic  Britons 
were  more  civilized  than  the  former,  and  lived  under  more 
artificial  conditions,  which  fact  will  help  sustain  the  theory 
advanced  by  me  that  the  higher  civilization  is  attended  with 
lessened  development  of  the  maxillae. 

"  Comparing  the  ancient  races  with  the  modern  races,  we 
find  the  range  of  the  former  is  2.12  to  2.02  inches,  while  that 
of  the  modern  is  2.12  to  2.87  inches.  Only  three  of  the 
modern  races,  however,  have  a  minimum  of  2.12,  while  the 
minimum  of  all  the  ancient  races,  with  the  exception  of  the 
Anglo-Saxons,  is  2.12  inches.  The  maximum  of  the  ancient 
races  is  less  than  that  of  the  former.  This  fact,  that  the  jaws 
of  these  people  are  smaller  than  those  of  the  modern  races, 
is  another  proof  of  the  truth  of  the  theor}'  that  civilization  is 
accompanied  by  decrease  in  the  size  of  the  jaw;  for  these 
ancient  races  were  possessed  of  a  higher  civilization  than  the 
modern  races,  who,  with  few  exceptions,  are  in  a  state  of 
barbarism. 

ANTERO-POSTERIOE    DIAjVIETEE. 

' '  The  antero-posterior  diameter  was  taken  from  the  alveolar 
process  at  a  point  between  the  central  incisors  extending  back- 
ward in  the  median  line  and  meeting  a  line  drawn  at  right 
angles  to  the  posterior  surface  of  the  third  molar,  as  illus- 
trated in  Fig.  10. 

''It  is  a  singular  fact  that  the  same  laws  hold  good  for  the 
development  of  the  antero-posterior  diameter  that  were  laid 
down  for  the  lateral  diameter.  Although  these  examinations 
were  made  by  different  persons,  in  different  parts  of  the  coun- 
try, we  find  that  the  antero-posterior  diameter  of  the  jaw  of 
the  female  is  less  than  that  of  the  male  by  from  .02  to  .24  of 


70 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


an  inch.  This  disparity,  as  compared  with  that  of  the  lateral 
diameters,  is  a  natural  one.  After  the  temporary  teeth  are 
all  in  place,  the  natural  development  of  the  jaw  is  in  an 
antero-posterior  direction,  and  the  natural  changes  that  are 
taking  place  in  the  evolution  of  the  face  and  jaws  consist  of  a 
shortening  of  the  antero-posterior  diameter.  The  great  range 
of  difference  is  due  to  the  fact  that  it  is  quite  common  to  find 
in  some  individuals  an  entire  arrest  of  development  of  the 
posterior  part  of  the  body  of  the  jaw.  This  is  always  the 
case  when  permanent  molars  have  been  extracted,  thus  allow- 
ing the  third  molar  to  come  forward,  or  when  the  individual 


Fig.  10. 

has  inherited  the  large  jaw  of  one  parent  and  the  small  teeth 
of  the  other  parent,  or  when  the  jaws  have  become  arrested 
in  development  from  constitutional  disease.  In  comparing 
the  antero-posterior  diameter  of  the  jaws  of  people  of  one 
nation  with  those  of  another  nation,  we  must  take  into  con- 
sideration the  character  of  the  skull.  In  the  brachycephalic 
type  of  the  Chinese  we  find  the  broad  jaw,  and  in  the  doli- 
chocephalic type  of  the  negro,  the  long  jaw.  This  difference, 
however,  is  only  applicable  to  the  pure  races,  and  can  be 
noticed  only  by  compai'ing  the  external  condition  of  the  head 
or  skull  with  the  jaw.  If  we  were  to  examine  two  or  three 
thousand  plaster  casts  of  the  mouths  of  a  mixed  class  of  peo- 


THE    HEAD,    FACE,    JAWS    AND    TEETH  71 

pie,  we  would  be  unable  to  say  that  this  one  belonged  to  a 
brachycephalic  individual  and  that  one  belonged  to  a  doli- 
chocephalic individual.  The  local  conditions  so  modify  the 
shape  of  the  jaw  that  in  the  mixed  classes  there  is  not  that 
correlation  between  the  shape  of  the  skull  and  jaw  which  we 
find  in  the  pure  races.  The  fact  that  the  jaw  develops  or 
lengthens  from  before  backward  would  naturally  impress  one 
with  the  fact  that  if  the  jaws  were  not  exercised  by  mastica- 
tion, or  if  any  of  the  permanent  teeth  had  been  extracted,  or 
if  a  third  molar  failed  to  make  its  appearance,  the  length 
required  would  necessarily  be  much  less  than  that  required 
by  a  jaw  full  of  teeth  and  one  that  had  been  well  exercised. 
Therefore  nature  developed  only  the  posterior  part  of  the 
jaw,  that  which  is  actually  necessary,  and  hence  the  short 
lower  jaw. 

HEIGHT    OF   VAULT. 

' '  The  height  of  the  vault  in  most  cases  is  far  below  the 
average  of  the  present  day.  In  4,614  measurements  of  nor- 
mal individuals,  made  by  the  author,  it  was  found  that  the 
average  height  of  the  arch  was  .58  of  an  inch;  the  measure- 
ment was  made  from  the  alveolar  border  between  the  second 
bicuspid  and  the  first  permanent  molar  to  the  height  of  the 
arch.  Fig.  11  illustrates  an  instrument  invented  by  me  for 
the  purpose  of  measuring  these  cases;  it  also  shows  the  posi- 
tion of  the  instrument  upon  the  model  when  the  measure- 
ment is  made. 

"It  was  necessary  to  group  both  male  and  female,  because 
some  of  the  measurements  were  taken  from  plaster  casts,  so 
that  I  was  unable  to  determine  the  sex. 

"In  comparing  the  width  of  the  jaws  of  people  whose 
ancestors  have  lived  in  this  country  for  many  years,  it  "will 
be  seen  that  there  is  not  such  a  great  difference  in  the  width 
of  the  jaws.  Thus,  private  female  patients  in  Burlington, 
Vt.,  Boston  and  Chicago,  show  that  there  is  only  about  .30 
mm.,  while  in  male  patients  only  about  1  mm. 

"By  comparing  these  measurements  with  the  ancient  Eng- 
lish, as  made  by  Mr.  Mummery  and  Mr.  Coleman,  we  find  a 


72 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


Fiff.  11. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  73 

difference  of  about  12  mm.,  and  the  difference  between 
ancient  Romans  about  the  same.  The  difference  between 
the  ancient  English  and  the  English  of  today  is  about  8  mm., 
and  the  ancient  Romans  and  present  Italians  of  Southern 
Italy  10.50  mm. 

"The  antero-posterior  diameter  of  the  present  size  of  the 
jaws  is  about  as  low  as  the  lowest  of  any  of  the  measure- 
ments, 

"By  comparing  my  measurements  of  New  England  stock 
with  the  ancient  Britons,  as  made  by  Mr.  Mummery  and  Mr. 
Coleman,  I  find  a  difference  from  7.79  to  12  mm.;  between 
ancient  Romans  and  New  England  stock  10.97  mm.;  between 
the  Anglo-Saxons  and  New  England  stock  9.38  mm.;  and 
between  New  England  stock  and  present  English  3.02  mm. 

"There  would  be  a  much  greater  difference  shown  in  the 
width  of  the  jaw  of  New  England  stock  of  today,  and  that  of 
the  skulls  of  early  races,  if  the  measurements  had  been  taken 
from  the  first  or  second  bicuspid  region,  because  the  greatest 
contraction  is  anterior  to  the  first  permanent  molar. 

' '  I  have  frequently  made  the  statement  that  the  teeth  are 
the  same  size  today  that  they  were  three  thousand  years  ago. 
These  measurements  bear  me  out  in  that  statement.  While 
the  lateral  diameter  of  the  jaws  is  considerably  smaller,  the 
antero-posterior  diameter  shows  only  a  slight  variation  as 
compared  with  those  of  other  tribes  and  nationalities.  In 
order  that  the  teeth  may  come  into  the  arch  uniforml}',  the 
anterior  alveolar  process  is  pushed  forward.  If  the  anterior 
alveolar  process  were  as  unresistible  as  the  lateral  alveolar 
process,  more  deformities  would  result. 

' '  That  the  wisdom-tooth  grows  smaller  as  we  ascend  the 
scale  of  civilization  is  upheld  by  many  writers.  But  even  in 
the  lower  races,  although  the  wisdom-tooth  does  not  present 
the  variations  that  are  found  in  more  civilized  races,  we  find 
that  it  is  far  inferior  to  the  teeth  of  the  ape  and  chimpanzee, 
although  among  these  animals  we  find  the  first  indication  of 
the  step  toward  the  degradation  and  subsequent  disappear- 
ance of  this  tooth.* 

*  Thompson,  "Care  of  the  Wisdoni-Tooth,"  etc. 


74  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

"^ut  the  tooth  in  all  these  cases  is  as  serviceable  as  the 
other  molars.  Among  some  of  the  monkey  tribes  the  third 
molar  is  of  equal  size  to  the  first  and  second,  while  again  in 
others  it  is  larger,  and  in  some  others  is  smaller.'^ 

"Mr.  Darwin  maintains  that  these  teeth  are  rather  larger 
than  the  other  two  molars  in  the  orang  and  chimpanzee,  f 

"Mr.  C.  S.  Tomes  says: :{:  *  In  macaques  the  third  molar  is 
larger  than  the  first  two,  and  is  qainquicuspid  below;  the  upper 
quadrieuspid.  It  is  generally  said  that  in  man  the  molars 
decrease  in  size  from  before  backward;  that  the  first  molar  is 
largest,  while  in  the  anthropoid  apes  the  contrary  is  the  case. 
This  is  true  on  the  whole,  but  requires  some  qualification,  as 
in  the  Australian  the  second  and  third  molars  are  not  smaller 
than  the  first,  and  of  the  chimpanzee  the  same  thing  may  be 
said  to  be  true.  In  the  anthropoid  apes  the  wisdom-tooth  is 
nearly  or  quite  as  large  as  the  other  molars,  and  shows  no 
variability,  while  it  comes  into  place  almost  simultaneously 
with  the  canine.  In  the  higher  apes,  such  as  the  gorilla,  the 
third  molar  is  in  every  respect  a  well-developed  tooth,  some- 
times even  larger  than  the  first  or  second  molar,  but  instead 
of  a  spongy,  softened  crown,  it  has  a  crown  on  which  the 
cusps  are  arranged  according  to  the  typical  pattern.'  He 
also  says  §  that  'the  wisdom-tooth  (in  lower  races)  has  ample 
space  to  range  with  the  other  teeth,  and  is  a  characteristic 
molar.  In  the  lower  races  of  mankind  the  wisdom-tooth 
appears  to  vary  but  little,  is  of  large  size,  and  is  never  mis- 
placed. In  the  more  civilized  races  it  is  quite  exceptional 
for  the  lower  wisdom-tooth  to  have  the  four  cusps  distinctly 
developed.  This  is  one  of  the  things  which  pointed  to  its 
disappearance.'  Mr.  Mummery  says:  'Among  the  stronger 
African  tribes  the  third  molar  was  always  present  in  the 
lower  jaw,  but  in  the  enfeebled  races  it  was  frequently 
absent.'  Professor  Allen  describes  the  third  and  fourth 
molars  of  an  Australian  skull,  which  show  a  tendency  to  the 

*  Professor  Owen. 

+  '' Descent  of  Man." 

X"  Dental  Anatomy." 

g  Proceedings  of  the  Odont.  Society  of  Great  Britain. 


THE    HEAD,    FACE,    JAWS   AND    TEETH  76 

bicuspidate  type.*  But  still  more  marked  differences  are 
found  between  the  savage  and  civilized  races  than  between 
the  savage  races  and  animals.  In  civilized  man  the  degraded 
condition  of  this  tooth  in  its  degeneracy  and  imperfection  is 
very  great,  as  compared  with  the  nearly  perfect  condition  of 
the  same  organ  in  the  lower  primates,  f 

"I  have  shown,  in  chapter  upon  alveolar  process,  that  the 
jaw  proper  and  the  alveolar  process  are  two  distinct  struct- 
ures; that  the  bone  proper  was  a  natural  development,  while 
the  alveolar  process  depended  entirely  upon  the  wedging  of 
the  teeth  against  each  other  for  its  size  and  shape.  Now, 
these  measurements  do  not  accurately  show  the  deviation  of 
the  jaw  proper  in  either  diameter  of  the  people  of  the  present 
day.  The  diameter  of  the  jaw  is  frequently  much  smaller 
laterally  and  antero-posteriorly  than  the  diameter  of  the  teeth 
and  alveolar  process,  which  every  observing  dentist  can  sub- 
stantiate. 

"The  average  height  of  vault  of  four  thousand  six  hundred 
and  fourteen  measurements  was  .58  of  an  inch,  while  the 
average  of  two  hundred  and  fifty-one  skulls  of  ancient  and 
modern  Romans,  Indians,  etc.,  was  .56;  allowing  for  the 
thickness  of  the  mucous  membrane,  the  average  height  of 
the  vault  of  the  present  people  would  be  a  little  below  that  of 
the  Indians,  negroes,  ancient  Britons  and  Romans. 

"In  investigating  the  subject  of  the  effects  of  disuse  of 
the  jaw  upon  its  development,  one's  attention  is  naturally 
directed  to  the  results  arising  from  disuse  of  any  organ  of  the 
body,  and  I  will  therefore  present  to  the  reader  some  data 
collected  by  me  upon  this  exceedingly  interesting  subject. 

"The  disuse  of  the  jaws  as  the  weapon  of  attack,  evident  in 
the  large  canines  of  the  male  anthropoid  apes,  exercised  an 
influence  in  reduction  of  the  size  of  the  jaw  itself  as  well  as 
on  the  teeth.  The  Neanderthaloid  jaw  is  a  type  of  jaw  from 
the  standpoint  of  the  anthropoid  apes,  and  the  few  weapons 
of  the  Neanderthal  types  of  man  indicate  that  biting,  as 
among  rowdies  of  today,  played  no  small  part  in  battle,  and 

*  Dental  Cosmos. 

t  Thompson,  "Care  of  the  Wisdom-Toofch,"  etc. 


76  ■  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

particularly  in  duels  for  female  favor.  With  the  develop- 
ment of  weapons  of  offense  this  employment  of  the  jaw  rap- 
idly fell  into  disuse.  The  physiological  factors  underlying 
this  element  are  similar  to  those  detailed." 

"  The  chief  agents  in  causing  organs  to  become  rudimentary 
seem  to  have  been  disuse  at  that  period  of  life  when  the  organ 
is  chiefly  used  (and  this  is  generally  during  maturity),  and 
also  inheritance  at  a  corresponding  period  of  life.  The  term 
disuse  does  not  relate  merely  to  the  lessened  action  of  muscles, 
but  includes  a  diminished  flow  of  blood  to  a  part  or  organ, 
from  being  subjected  to  fewer  alterations  of  pressure  or  from 
becoming  in  any  way  less  habitually  active. 

"Rengger  attributes  the  thin  legs  and  thick  arms  of  the 
Paraguay  Indians  to  successive  generations  having  passed 
nearly  their  whole  lives  in  canoes,  with  their  lower  extremi- 
ties motionless.  Other  writers  have  come  to  a  similar  con- 
clusion in  analogous  cases.  It  is  asserted  that  the  hands  of 
English  laborers  are  at  birth  larger  than  those  of  the  gentry,  f 

"  From  the  correlation  which  exists,  at  least  in  some  cases, 
between  the  development  of  the  extremities  and  of  the  jaws, 
it  is  possible  that,  in  those  who  do  not  labor  much  with  their 
hands  and  feet,  the  jaws  would  be  reduced  in  size  from  this 
cause.  That  they  are  generally  smaller  in  refined  and  civi- 
lized men  than  in  hard-working  men  or  savages,  is  certain; 
but  with  savages,  as  Herbert  Spencer  has  remarked,  the 
greater  use  of  the  jaws  in  chewing  coarse,  uncooked  food 
would  act  in  a  direct  manner  on  the  masticatory  muscles,  and 
on  the  bones  to  which  they  are  attached.* 

"  It  is  familiar  to  everyone  that  watchmakers  and  engravers 
are  liable  to  be  short-sighted,  while  men  living  much  out  of 
doors,  and  especially  savages,  are  generally  long-sighted. 
Short-sight  and  long-sight  tend  to  be  inherited.:}: 

"It  is  a  singular  fact  that  sailors  are  inferioi  to  landsmen 
in  their  mean  distance  of  distinct  vision.  This  is  probably 
due  to  the  fact  that  the  ordinary  range  of  vision  in  sailors  is 

*  Darwin. 
t  Walker. 
X  Ibid. 


THE    HEAD,    FACE,    JAWS   AND    TEETH  77 

restricted  to  the  length  of  the  vessel  and  the  height  of  the 
mast* 

"  The  inferiority  of  Europeans,  in  comparison  with  savages, 
in  eyesight  and  in  other  senses,  is  no  doubt  the  accumulated 
and  transmitted  effect  of  lessened  use  during  many  genera- 
tions, f  Europeans  who  have  been  brought  up  and  spent  their 
whole  lives  with  the  wild  Indians  do  not  equal  them  in  the 
sharpness  of  their  senses.  The  cavities  in  the  skull  for  the 
reception  of  the  several  sense-organs  are  larger  in  the  Ameri- 
can aborigines  than  in  Europeans.  This  probably  indicates  a 
corresponding  difference  in  the  dimensions  of  the  organs 
themselves.  :j: 

"The  Mongolians  of  the  plains  of  Northern  Asia  are  char- 
acterized by  great  breadth  of  the  skulls  across  the  zygoma. 
This  follows  from  the  highly-developed  sense-organs.  §  In 
the  lower  jaw  of  many  pigeons  the  articular  surface  is  pro- 
portionably  smaller  than  in  the  rock  pigeon,  and  the  vertical 
diameter,  more  especially  of  the  outer  part  of  the  articular 
surface,  is  considerably  shorter.  May  not  this  be  accounted 
for  by  the  lessened  use  of  the  jaws,  owing  to  nutritious  food 
having  been  given  during  a  long  period  to  all  highly-improved 
pigeons? t 

"One  of  the  chief  factors  conducive  to  arrest  of  develop- 
ment of  the  jaws,  and  one  which  acts  in  a  threefold  ratio,  is 
the  want  of  maxillary  exercise.  This  operates  in  the  follow- 
ing manner:  First,  by  lack  of  exercise,  the  blood,  which 
nourishes  the  bones,  is  not  carried  to  the  part;  second,  the 
blood  does  not  carry  sufficient  material  to  the  teeth,  hence  the 
enamel  formed  is  defective,  and  as  a  result  we  have  early 
deca}' ;  third,  by  lack  of  lateral  motion,  the  mechanical  develop- 
ment of  the  alveolar  process  is  wanting.  It  has  been  shown 
that  the  jaws  of  today  are  not  so  large  as  those  of  prehistoric 
races,  and  that  they  are  steadily  growing  smaller.  The  early 
races  lived  upon  coarse  food,  such  as  roots,  herbs,  corn,  and 

*  B.  A.  Gould. 

t  Darwin. 

i  Rengger  and  Blumenbach. 

S  Prichard. 


78  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

uncooked  meats.  This  coarse  food  required  considerable 
mastication  in  order  to  be  prepared  for  the  chemical  changes 
which  are  necessary  before  assimihition  can  take  place.  As 
a  result  of  use,  the  muscles  of  the  jaw  were  dense  and  hard, 
and  when  contraction  took  place  they  stood  out  upon  the 
sides  of  the  head  like  large  cords.  The  bones  were  well 
developed;  they  were  also  of  dense  and  hard  structure;  the 
processes  for  the  attachment  of  muscles  were  prominent  and 
large,  and  the  teeth  were  large  and  set  deep  in  the  alveolar 
process. 

"These  physical  conditions  are  noticeable  only  in  those 
persons  who  use  their  masticatory  apparatus  a  great  deal,  as 
to bacco-ch ewers,  and  are  also  seen  in  public  speakers  and  sing- 
ers. To  such  an  extent  has  the  art  of  mastication  become 
obsolete  that  the  food  is  now  swallowed  whole,  or  in  a  semi- 
masticated  condition.  The  muscles  have  become  flabby,  the 
jaws  more  slender,  and  the  processes  for  the  attachments  of 
muscles  are  almost,  if  not  quite,  obliterated.  The  diflerence 
in  the  size  of  the  superior  and  inferior  maxillae  is  a  marked 
illustration  of  the  result  arising  from  the  use  and  disuse  of 
these  bones.  It  is  a  singular  fact  that  the  greater  number  of 
irregularities  of  the  teeth  occur  upon  the  upper  jaw;  when 
they  are  found  upon  the  lower  jaw,  the  irregularities  are  due 
to  local  causes. 

"The  upper  jaw  is  a  fixed  bone,  and  the  blood-supply  is 
small  from  a  lack  of  stimulus — i.e.,  movement,  and  hence 
arrest  of  development  is  marked.  On  the  other  hand,  the 
lower  jaw  being  movable,  more  blood  flows  to  the  part,  which 
thus  becomes  much  more  developed. 

"As  a  further  illustration  of  the  results  arising  from  the 
use  and  disuse  of  the  upper  and  lower  jaws,  I  desire  to  direct 
attention  to  the  following  fact:  It  is  known  to  all  dentists 
that  the  teeth  upon  the  upper  jaw  are  more  subject  to  decay 
than  those  upon  the  lower  jaw,  although  the  environment  of 
the  teeth  upon  the  lower  jaw,  especially  the  bicuspids  and 
molars,  renders  them  more  subject  to  decay  than  those  upon 
the  upper.  Tomes  says:*    '  The  diiferent  teeth  are  not  equally 

*  "Dental  Surgery,"  p.  273. 


THE     HEAD,    FACE,    JAWS    AND   TEETH  79 

subject  to  the  attacks  of  caries.  In  the  first  place  the  upper 
are  more  frequently  attacked  than  the  lower — according  to 
Dr.  Magitot  in  the  proportion  of  3:2 — whilst  the  yet  more 
comprehensive  tables  of  Dr.  Hitchcock  give  the  ratio  of 
1.9:1,  or  very  nearly  two  to  one.'  A  disease  which  is  becom- 
ing a  very  common  one  among  our  people,  and  which  is  in  a 
great  measure  due  to  want  of  proper  mastication,  is  that 
called  'Riggs'  disease.'  The  first  symptom  noticed  is  a 
slight  redness  along  the  margin  of  the  gums.  These  after- 
ward become  swollen  and  bleed  upon  the  slightest  touch; 
then  follow  inflammation  of  the  peridental  membrane,  absorp- 
tion of  the  alveolar  process,  and  consequent  loss  of  the  teeth. 
To  such  an  extent  has  this  disease  become  prevalent,  that  at 
least  ninety-five  per  cent  of  all  people  over  twenty-five  years 
of  age  are  thus  more  or  less  afflicted.  Twenty-five  years  ago 
this  disease  was  not  considered  of  any  importance  by  the 
dentist,  due,  no  doubt,  to  its  comparatively  rare  occurrence. 
Today  it  is  giving  him  more  trouble  than  decay  of  the  teeth, 
because  a  dentist  is  frequently  called  upon  by  patients  who 
have  a  partial  or  full  set  of  natural  teeth  which  are  quite 
loose  in  the  jaw;  aside  from  this  they  are  sound  and  healthy, 
and  after  a  certain  stage  in  the  development  of  the  disease 
nothing  can  be  done  to  save  them;  while  on  the  other  hand, 
if  decay  takes  place,  by  constant  filling  they  can  be  preserved. 
"  These  conditions  are  brought  about  by  a  change  in  the 
mode  of  living.  Man  first  began  to  reduce  food  by  cooking, 
in  order  to  make  it  more  palatable.  Roots,  herbs,  and 
grains  were  more  finely  divided  by  mechanical  means,  and 
thus  the  labor  of  the  jaws  in  mastication  was  lessened.  Since 
these  early  beginnings  man  has  studied  the  art  of  the  prepara- 
tion of  food,  and  today  it  is  prepared  in  such  a  manner  that 
in  most  cases  mastication  is  unnecessary.  While  these 
changes  in  the  preparation  of  the  food  have  taken  place,  man 
has  been  modified  not  only  as  regards  his  sense  of  taste  and 
appetite,  but  also  in  the  structure  of  musples  and  jaws. 
'Surely,'  says  Mr.  Carter,  in  the  British  Journal  of  Dental 
Science,  in  speaking  of  the  jaws  and  teeth,  '  some  law  of 
God  and  nature  has  been  outraged  to  bring  upon  our  children 


80  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

SO  dire  au  aftliction.'  To  sach  an  extent  has  the  sense  of 
taste  and  refined  appetite  become  cultivated,  that,  at  the 
present  day,  it  requires  all  the  skill  that  cooks  are  able  to  dis- 
play to  produce  dishes  free  from  all  of  the  peculiarities  pre- 
sented in  the  early  days  of  cooking.  Thus  all  coarseness  has 
been  removed  from  food,  and  by  the  new  processes,  made 
possible  by  mechanical  as  well  as  scientific  discoveries,  cereals 
are  reduced  to  the  finest  of  flour,  while  the  hulls,  which  con- 
tain the  phosphates  essential  to  bone-building  and  also  furnish 
the  material  for  mechanical  grinding  by  the  jaw,  are  entirely 
excluded.  There  seems  to  be  a  growing  inclination  on  the 
part  of  the  human  race  to  use  that  class  of  food  which 
requires  little,  if  any,  mastication.  This  evolution  will  eventu- 
ally result  in  the  adoption  of  new  modes  of  acquiring  and 
preparing  food,  viz:  the  manufacture  of  foods  in  the 
chemical  laboratory.  Indeed,  at  the  present  time  many 
forms  of  food,  comprising  all  the  nutritive  elements  necessary 
to  sustain  life  for  the  sick,  are  being  prepared  in  the  labora- 
tory. If  these  foods,  prepared  in  a  liquid  form,  are  sufficient 
for  the  nourishment  of  children  and  the  sick,  it  seems  reason- 
able to  expect  that  they  will  soon  become  the  exclusive  food 
of  the  laboring  class,  and  indeed  of  all  classes.  Such  being 
the  case,  the  art  of  mastication,  which  is  now  at  a  very  low 
ebb,  will  then  become  entirely  lost. 

"I  have  shown  that  when  the  teeth  push  their  way  into 
place  they  crowd  one  another  laterally.  By  so  doing  the 
dental  arch  enlarges,  and  the  alveolar  process  develops  and 
grows  about  the  teeth.  The  lateral  movement  of  the  lower 
jaw  in  the  act  of  chewing  assists  greatly  in  producing  the 
enlargement.  The  constant  movement  of  the  lower  against 
the  upper  teeth  causes  them  (in  many  cases  of  irregularities) 
to  arrange  themselves  in  their  proper  places.  The  teeth  of 
tobacco-chewers  are  rarely  irregular.  Thus  we  see  that  the 
result  of  the  proper  mastication  of  food  has  brought  about 
arrest  of  development  of  the  jaw,  and  consequent  irregu- 
larity of  the  teeth. 

"As  far  as  the  jaws  and  teeth  are  concerned,  they  may 
exist  in  each  parent  in  perfect  symmetry:  in  one  parent  the 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


SI 


jaws  and  teeth  are  large;  in  the  other  parent  both  jaws  and 
teeth  are  small;  but  each  in  its  way  is  a  normal  development. 
If,  now,  the  small  jaw  of  one  parent  and  the  large  teeth  of 
the  other  appear  in  the  offspring,  deformity  is  sure  to  follow. 
Benedict  declares*  that  abnormality  of  structure  predisposes 
to  disease,  and  among  abnormalities  of  structure  he  mentions 
particularly,  pathological  length  and  breadth  of  the  face, 
pathological  relations  of  the  sutures,  asymmetry,  and  inter- 
calaria. 

"The  most  convincing  proof  that  one  of  the  great  causes  of 
abnormalities  of  the  jaws  is  due  to  race  mixture,  is  the  fact 
that  these  abnormalities  are  not  found  in  a  pure  race,  e.  g.^ 
the  Chinese  and  negro  races.     By  examining  the  figures  of 


Fig.  12. 


Fig.  13. 


Fig.  14. 


the  dolichocephalic  (Fig.  12),  Sarmatic  brachycephalic  (Fig. 
13),  and  the  Turanic  or  extreme  brachycephalic  (Fig.  14) 
types,  it  will  be  seen  at  a  glance  how  entirely  different  must 
be  the  single  measurements,  not  only  of  the  skull  generally, 
but  of  the  face,  and  particularly  the  superior  maxillary  bones. 
These  types  represent,  to  a  greater  or  less  degree,  the  Ger- 
man, Slav  and  Finno-Magyar  skulls  of  the  present  day, 
though  it  is  probable  that  the  differences  are  not  so  sharply 
drawn  in  living  specimens. 

"Anthropologists  agree  that  racial  differences  and  pecu- 
liarities are  shown  more  clearly  by  the  skull  as  a  whole  than 
by  any  other  portion  of  the  skeleton.  It  is  to  be  supposed, 
then,  that  in  a  mixture  of  two  races  with  important  cranial 
differences,  an  attempt  by  nature  to  mix  the  types,  without 

*  Kraniometrie  und  Kephalometrie.     Wien,  1888. 


82  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

the  ability  to  blend  them  harmoniously,  must  result  in  an 
irregularity  or  abnormality.  This  argument  is  borne  out  in  man 
in  the  predominance  of  the  cerebral  and  nervous  functions,  and 
of  the  chief  individual  difierences  being  found  in  the  face,  in 
variations  as  to  form,  to  a  certain  extent,  temperament  and 
cranial  structure.  It  is  simply  a  matter  of  evolution,  of 
change  and  reformation  of  type.  But  in  civilized  com- 
munities the  law  of  survival  of  the  fittest  is  practically 
annulled. 

"Let  us  suppose,  for  example,  that  a  person  with  the  form 
of  cranium  shown  in  Fig.  12  be  married  to  one  with  the  form 
seen  in  Fig.  14.  It  seems  scarcely  possible  that  there  could 
be  a  perfectly  harmonious  blending  of  the  cranial  differences 
in  these  types,  even  if  both  parents  were  in  perfect  health, 
and  the  offspring  remain  in  perfect  health  throughout  infancy, 
which  may  be  said  never  to  obtain  in  civilized  communities. 
And  what  must  be  the  result  if  nature  attempt  to  combine 
what  may  be  called  the  intellectual  cranium  of  Fig.  12  with 
the  animal  strength  of  face  and  jaws  of  Fig.  14?  Clearly, 
deformity,  or  at  the  least,  irregularity.  Nature  could  never 
fit  the  superior  maxilla  of  Fig.  14  into  the  face  of  Fig.  12. 
There  is  no  incongruity  involved  in  believing  that  she  would 
attempt  this.  The  law  of  inheritance  —  call  it  nature  or  what 
else  — that  insists  upon  perpetuating  supernumerary  digits 
and  the  like,  would  not  stop  at  harmless  peculiarities,  as  is 
shown  by  the  distinct  inheritance  of  disease,  such  as  cancer, 
tuberculosis,  heart  disease,  etc.  Nor  is  it  too  much  to  assert 
that  neuroses,  which  are  distinctly  hereditable,  are,  in  a  large 
measure,  due  to  abnormalities  in  the  conformation  of  the 
cranium." 

It  would  seem,  then,  that  from  what  has  been  said  and 
from  actual  measurements  of  the  jaws,  that  no  matter  what 
the  views  of  the  reader  may  l)e  in  regard  to  the  degeneracy 
of  the  jaws  of  the  human  race,  he  must  be  convinced  that 
the  jaws  of  the  human  race  are  gradually  growing  smaller. 
Because,  when  we  examine  the  mouth  of  an  individual,  we 
find  that  the  teeth  in  both  jaws  are  normally  developed,  it  is 
no   sign   that   the  jaw  is  sufficiently  large  to  accommodate 


THE  HEAD,  FACE,  JAWS  AND  TEETH  83 

them.  If  we  raise  the  lip  on  the  upper  jaw  or  depress  it  on 
the  lower,  in  fully  50  per  cent  of  our  patients,  and  pass  the 
finger  along  the  alveolar  process  at  the  apices  of  the  roots  of 
the  teeth,  we  will  find  quite  a  depression.  This  shows  that 
although  the  jaws  are  undeveloped,  the  teeth  have  wedged 
their  way  into  place  and  have  carried  the  alveolar  process 
with  them,  thus  demonstrating  that  those  who  are  in  the 
habit  of  using  their  jaws  freely  have  the  advantage  of  a 
normal  development  over  those  unfortunate  individuals  who 
do  not  masticate  their  food. 


CHAPTER  VII. 

DEVELOPMENT  OF  THE  VAULT. 

The  roof  of  the  mouth  has  received  several  names  from 
different  authors;  one  speaks  of  it  as  the  arch,  another  the 
dome,  still  a  third  the  palate.  The  word  arch,  although  used 
in  its  proper  place,  is  so  often  liable  to  be  confounded  with  the 
dental  arch  that  one  is  apt  to  become  confused.  Thus  we 
frequently  read  of  the  V  or  saddle-shaped  arch,  and  we  are 
quite  unable  to  decide  whether  the  writer  intended  to  refer  to 
the  dental  arch  or  the  roof  of  the  mouth.  The  author  has  in 
former  papers  used  the  term  vault  to  distinguish  it  from  the 
dental  arch,  and  shall  therefore  continue  its  use  in  the  pres- 
ent volume. 

The  vault  of  the  mouth  is  made  up  of  the  hard  palate,  the 
soft  palate,  and  the  alveolar  process.  The  hard  palate  con- 
sists of  two  horizontal  plates  of  bone  extending  from  the 
superior  maxillary  bone  upon  either  side  and  uniting  at  the 
median  line,  and  from  the  anterior  alveolar  process  in  front, 
it  extends  back  on  an  average  of  two  inches,  when  it  unites 
with  the  soft  palate.  The  hard  palate  is  composed  of  six  dis- 
tinct parts;  two  incisive  bones,  two  palate  plates  of  the  sup- 
erior maxillae,  and  two  horizontal  plates  of  the  palate  bones. 
The  incisive  bones,  however,  become  so  firmly  united  to  the 
maxillary  plate  of  bone  so  early  in  life  that  the  suture 
becomes  obliterated.  The  period  of  ossification  of  the  median 
suture  varies  in  different  individuals,  sometimes  as  early  as 
the  third  and  fourth  years,  and  again  as  late  as  the  fifteenth 
and  sixteenth  year. 

The  author,  in  widening  the  arch  by  means  of  a  jack 
screw,  has  opened  the  suture  of  the  median  line  in  fourteen 
different  cases  in  children  from  twelve  to  sixteen  years  of  age. 
This  was  accomplished  by  very  little  pressure,  showing  that 
union  had  not  taken  place;  these  were  all  neurotic  patients. 

As  a  whole,  the  hard  palate  may  be  described  as  a  hori- 
zontal partition,  or  floor,  separating  the  nasal  cavity  from  the 

S4 


THE    HEAD,    FACE,    JAWS    AND   TEETH  85 

mouth.  The  anterior  part  of  the  palate  bone  unites  with  and 
becomes  a  part  of  the  alveolar  process.  The  upper  surface  of 
the  hard  palate  joins  the  floor  of  the  nasal  passages,  which 
are  divided  in  the  center  by  the  union  of  the  vomer.  This 
bone,  which  is  quite  thin  at  its  middle  portion  and  cartilagi- 
nous at  the  anterior  part,  begins  to  thicken  as  it  reaches  the 
floor  of  the  nose,  at  which  place  it  gradually  produces  a 
smooth  appearance,  dividing  the  nostril  into  two  rounded 
arches. 

Upon  the  palatal  surface  it  is  very  uneven.  Along  the 
median  line  we  frequently  find  a  rough  ridge  of  bone,  resem- 
bling a  section  of  rope,  running  its  entire  length,  about  the 
size  of  a  slate  pencil.  Such  a  condition  is  frequently  observed 
in  Peruvian  skulls.  Out  of  228  examined  at  the  Peabody 
Museum,  Harvard  College,  sixteen  had  this  peculiar  appear- 
ance. In  more  modern  skulls  we  find  knots,  or  rough  lumps 
of  bone,  at  intervals  along  the  suture.  Again,  we  will  observe 
a  thick  band  of  bone  from  .25  to  .50  of  an  inch  in  width, 
extending  part  way  or  the  entire  length  of  the  suture.  This 
thickness,  or  prominence,  commences  at  the  alveolar  border 
and  becomes  the  widest  at  the  second  bicuspid  and  first  per- 
manent molar,  where  it  gradually  narrows  to  a  mere  point  at 
a  line  drawn  across  the  vault  at  the  posterior  surface  of  the 
second  molar. 

The  hard  palate  varies  in  thickness  in  difierent  localities 
and  differs  in  thickness  in  different  individuals.  Around  the 
edge  where  it  unites  with  the  maxillary  bone  and  alveolar 
process  it  is  quite  thick,  and  also  at  the  median  line;  while 
about  midway  between  these  two  parts  the  bone  is  as  thin  as 
tissue  paper.  I  have  also  observed  it  from  .12  to  .18  of  an 
inch  in  thickness.  At  the  median  line,  and  just  back  of  the 
incisors,  we  find  a  fossa  which  transmits  the  anterior  palatine 
vessels  and  naso-palatine  nerves.  At  the  posterior  surface  upon 
either  side  is  a  groove  and  an  opening  for  the  transmission 
of  the  posterior  palatine  vessels  and  nerves.  Both  the  upper 
and  lower  surfaces  of  the  hard  palate  are  covered  with  mucous 
membrane,  which  extends  backward  and  unites  to  form  the 
soft  palate.     Between  the  two  folds  of  mucous  membrane  are 


86 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


muscular  Hbrcs  for  the  purpose  of  moving  the  soft  palate  in 
different  directions.  The  shape  and  length  of  the  soft  palate 
depends  upon  the  distance  between  the  oesophagus  and  the 
edge  of  the  hard  palate.  If  the  head  of  the  individual  is 
dolichocephalic,  or  long,  the  soft  palate  will  curve  slowly 
backward,  thus  producing  quite  a  long  space  between  the 
incisor  and  uvula.  On  the  other  hand,  if  the  person  possesses 
a  brachycephalic,  or  short  head,  the  soft  palate  will  curve 
abruptly,  thus  allowing  only  a  short  distance  in  the  vault  of 
the  mouth.     I  have  observed  mouths  where  the  head  was  so 


short  from  front  to  back  that  the  soft  palate  descended  nearly 
straight  down  without  the  slightest  curve. 

The  vault,  taken  as  a  whole,  presents  different  shapes  in 
different  individuals. 

The  above  description  of  the  anatomy  of  the  vault  is  quite 
sufficient  for  the  purpose  of  the  student.  Should  he  require 
further  details,  he  is  referred  to  the  standard  text-books. 


NORMAL  DEVELOPMENT  OF  THE  ROOF  OF  THE  VAULT. 

If  we  will  examine  the  mouth  of  a  child  at  the  fourth  or 
fifth  year,  we  will  find  a  well-developed  jaw.  The  curves 
are  all  graceful  in  outline,  and  the  contour  of  the  dental  arch 


THE    HEAD,    FACE,    JAWS    AND    TEETH  87 

is  well  formed.  This  could  hardly  be  otherwise,  for  the  rea- 
son that  the  jaw  is  growinj^  rapidly  for  the  purpose  of 
accommodating  the  permanent  teeth,  and  the  circle  of  the 
alveolar  process  is  larger  than  that  of  the  teeth.  Spaces 
exist  between  the  teeth,  and  therefore  crowding  cannot  take 
place. 

We  could  not  expect  to  find  two  vaults  alike  in  height, 
width  or  contour,  although  each  is  normal  in  itself.  We 
shall  see  in  the  chapter  upon  the  alveolar  process,  that  in  the 
development  of   the   jaws  we  have  two  structures,  the  hard, 


Fig.  16. 

dense  bone  of  the  maxilla  and  hard  palate,  and  the  soft, 
spongy  bone — the  alveolar  process.  The  maxillary  bones 
develop  and  unite  at  the  median  line.  The  contour  of  the 
top  of  the  vault  is  now  established.  It  is  held  in  position, 
on  the  sides,  by  the  walls  of  the  antrum,  supported  by  the 
malar  process  and  by  the  anterior  alveolar  process  and  max- 
illary bone.  In  this  manner  the  vault  is  held  in  its  natural 
position.  The  maxillary  bones,  like  all  the  other  bones  of 
the  head,  develop  in  every  direction  in  a  general  way,  until 
the  growth  is  established.  Between  the  period  of  birth  and 
two  years  (when  all  the  temporary  teeth  are  in  place)  and 
twelve  or  fourteen  years  (when  all  the  permanent  teeth  are 


88  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

in  position)  great  changes  take  place  in  the  shape  of  the  jaw 
This  change  is  nicely  ilhistrated  in  Figs.  15  and  16. 

Fig.  15  illustrates  the  face  of  a  girl,  three  years  of  age, 
the  bones  of  the  face  and  head  all  undeveloped.  The 
bridge  of  the  nose  is  sunken,  the  upper  lip  is  short,  as  well 
as  the  jaw  from  the  lower  lip  to  the  chin.  How  different 
the  appearance  of  the  same  girl  at  thirteen  (Fig.  16).  While 
the  width  from  cheek  to  check  has  not  changed  to  any  great 
extent,  the  length  of  the  face  from  the  chin  to  the  top  of  the 
head  is  veiy  marked.  No  part  of  the  face  has  changed  more 
than  the  lower — from  the  nose  down.  This  change  is  due 
partly  to  the  change  in  the  angle  of  the  lower  jaw,  and  partly 
to  the  development  downward  of  the  superior  alveolar  pro- 
cess. In  yoimg  life,  the  lower  jaw  presents  an  obtuse  angle; 
this  gradually  changes  until  at  middle  life  it  assumes  a  right 
angle.  In  order  that  the  alveolar  process  and  teeth  may 
compensate  for  this  change  as  the  second  set  comes  into  posi- 
tion, the  alveolar  process  lengthens  with  the  eruption  of  the 
teeth.  This  is  proven  by  the  location  of  the  mental  foramen, 
which  is  situated  at  the  superior  border  of  the  lower  jaw 
earlv  in  life,  and  at  middle  life  just  midway  between  the 
upper  and  lower  border  of  the  bone.  The  same  changes 
take  place  in  the  upper  jaw.  This  is  quite  noticeable  on  the 
sides  of  the  alveolar  process  at  the  roots  of  the  first  perma- 
nanent  molar  soon  after ^it  has  erupted.  Upon  examination 
(see  Plates  1,  2,  3  and  4),  we  shall  observe  what  seems  to  be  a 
depression,  but  by  a  careful  examination  we  find  that  it  is  a 
lengthening  of  the  alveolar  process.  When  the  crowns  of  the 
bicuspids  are  ready  to  advance,  and  absorption  of  the  roots  of 
the  temporary  molars  take  place,  there  is  some  irritation  in 
the  alveolar  process.  The  first  permanent  molar  coming 
into  position  advances  further  than  the  line  of  articulation  of 
the  temporary  molars,  and  the  pressure  of  the  jaws  rests 
upon  the  first  permanent  molars.  This  fact,  together  with 
the  irritation  already  mentioned,  has  a  tendency  to  lengthen 
the  alveolar  process,  so  that  when  the  bicuspids  come  into 
place  there  is  a  difference  in  the  height  of  the  vault.  There 
are  plenty  of  illustrations  to  show  this  development  of  the 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


89 


alveolar    process,  and   every   practitioner  of    dentistry   has 
observed  this. 

One  of  the  most  common  illustrations  is  that  when  the 
molar  teeth  upon  the  lower  jaw  have  been  extracted,  the 
molars  upon  the  upper  jaw  (for  want  of  antagonists)  drop 
down  by  the  lengthening  of  the  alveolar  process.  The  dif- 
ference in  the  height  of  vault  when  the  temporary  teeth  are 
in  place  and  when  the  permanent  teeth  erupt  is  nicely  illus- 
trated in  Fig.  17.  This  cut  shows  the  permanent  incisors 
and  first  molars  in  place.  Note  the  lengthening  of  the 
alveolar  process.     In  this  manner  we  obtain  the  difierence  in 


Pig.  17. 

the  length  of  the  face.  In  those  cases  where  the  vault  is 
very  high,  the  alveolar  process  is  always  very  long  and  thin. 
This  change  in  the  alveolar  process  is  nicely  illustrated  in 
Nos.  21  and  22,  Plate  4,  ten  years,  and  in  Nos.  32,  33  and 
35,  Plate  6,  twelve  years.  In  No.  21,  Plate  4,  the  temporary 
teeth  have  been  extracted,  and  the  bicuspids  have  not 
erupted,  while  upon  the  left  side  the  bicuspid  is  just  coming 
through;  on  this  side  the  alveolar  process  is  lengthening. 
The  same  is  true  in  No.  22,  but  on  the  reverse  side.  This  is 
more  marked  in  Nos.  32,  33  and  35.  The  temporary  teeth, 
however,  remain  in  the  last  three  cases.  The  depth  of  vault 
is  also  governed  by  the  angle  of  the  jaw.     Thus,  if  from 


90 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


inherited  constitutional  disease,  such  as  consumption,  syphilis, 
etc.,  arrest  of  development  of  the  maxillae  should  ensue,  the 
angle  would  not  change  from  an  obtuse  to  a  right  angle.  It 
will  be  noticed  that  when  the  mouth  is  opened  the  anterior 
part  has  to  travel  a  greater  distance  than  the  posterior  part, 
hence  either  the  anterior  inferior  alveolar  process  will 
elongate  so  that  the  lower  incisor  will  articulate  with  the 
upper  (Fig.  25),  or  the  anterior  superior  alveolar  process  will 
elongate  to  meet  the  lower  incisor  and  bicuspid  (Figs.  117, 
lis,  119).     Occasionally  this  will  take  place  in  both  jaws. 


i^Mg.  18. 

In  either  case  the  superior  alveolar  process  becomes  long  and 
thin,  and  the  vault  is  quite  high.  In  cases  of  arrest  of  devel- 
opment of  the  bones  of  the  nose  and  adenoid  growths,  when 
it  is  impossible  for  the  child  to  breathe  throusfh  the  nose, 
and  mouth-breathing  is  a  necessity,  the  jaws  are  separated, 
and  the  teeth  not  having  a  resting  place,  the  alveolar  process 
elongates  and  a  high  vault  is  almost  always  noticed;  hence 
the  reason  why  imbeciles  and  all  degenerates  who  keep  the 
mouth  open,  as  a  rule,  have  high  vaults.  The  high  vaults 
and  prominent  teeth,  and  upper  alveolar  process  due  to  this 


THE    HEAD,    FACE,    JAWS    AND    TEETH  91 

cause,  are  nicely  illustrated  in  Fig.  18,  etc.  On  the  other 
hand,  we  occasionally  notice  the  jaws  brought  closely 
together.  This  is  due  (1)  to  a  short  ramus;  (2)  to  right 
angles  of  the  rami  to  the  body  of  the  jaw;  (3)  to  arrest  of 
development  of  the  alveolar  process,  and,  (4)  to  teeth  with 
short  crowns,  or  teeth  not  fully  erupted.  In  such  cases  the 
vault  is  low,  the  alveolar  process  thick,  and  usually  the  lower 
jaw  is  quite  broad.  The  lips  pout,  the  face  is  short  and 
broad.  Frequently  the  upper  jaw  is  arrested  in  its  develop- 
ment; the  muscles  of  mastication  are  very  set  and  rigid. 
Such  a  case  is  illustrated  in  Fig.  19. 

The  height  of  the  vault,  then,  is  not  due  to  the  roof's 


Fig.  1*1. 

being  pushed  or  pulled  up  by  a  pressure  exerted  through  the 
vomer  by  the  development  of  the  sphenoid  bone,  nor  does 
the  shape  of  the  base  of  the  skull  in  any  wa}^  affect  it,  as  I 
have  already  explained.  The  height  is  due  entirely  to  a 
growth  downward  of  the  alveolar  process  and  teeth.  The 
extent  of  the  development  of  the  alveolar  process  depends 
upon  Nature's  becoming  satisfied  with  her  architectural 
figures,  and  harmonizing  the  jaws,  alveolar  process,  and 
length  of  teeth.  That  the  distance  in  height  is  chano-ed  from 
a  child  to  a  person  of  middle  life  is  demonstrated  by  the  fol- 
lowing figures:  Thus  in  317  children,  under  five  years  of 
age,  before  the  development  of  the  first  permanent  molar  and 


92         "  ETIOLOGY  OF  OSSEOU8   DEFORMITIES   OF 

alveolar  process,  the  lowest  vault  measured  .17;  the  highest 
.62,  with  an  average  of  .42.  If,  now,  we  notice  the  height  of 
vaults  in  children  at  different  ages,  we  find  a  gradual  advance 
in  the  height  of  the  vaults  until,  in  4,61-1:  adult  vaults,  we 
have:  lowest,  .21,  highest,  .81:,  with  an  average  of  .58.  It 
will,  therefore,  be  observed  that  the  height  of  vault  develops 
about  .25  to  .33  in  depth  after  the  permanent  teeth  com- 
mence to  erupt.  In  908  measurements  of  the  vaults  of 
ancient  and  modern  Romans,  Peruvians,  Sandwich  Islanders, 
Mound  Builders,  American  Indians,  negroes,  etc.,  the  mini- 
mum height  of  vault  was  .25,  while  the  maximum  height  was 
.88;  average,  .53.  By  comparing  these  figures  with  those  of 
modern  individuals,  the  lowest  vault  is  a  little  higher — .04 — 
than  in  modern,  and  the  highest  a  little  higher — ^.04.  The 
average,  however,  is  a  little  lower  than  in  the  modern  vaults 
by  .05,  thus  showing  that  the  ancient  and  pure  individuals 
possess  more  uniform  and  lower  vaults  than  modern.  We 
would  conclude,  therefore,  that  the  height  of  the  vault 
depends  upon  the  length  of  the  face  from  the  chin  to  the  top 
of  the  head.  So  far  as  the  height  of  the  vault  is  concerned, 
no  race,  type,  sect,  or  intellect  can  lay  claim  to  high, 
medium,  or  low  vaults.  They  all  exist  in  all  classes  of  indi- 
viduals. 

NORMAL   VAULT. 

What  constitutes  a  normal  vault  would  be  a  difficult  ques- 
tion to  answer.  I  possess  six  skulls,  obtained  under  diffi- 
culties from  a  medical  college,  and  not  selected  for  any  par- 
ticular purpose. 

The  lateral  measurement  was  made  between  the  roots  of 
the  second  bicuspids,  and  the  antero-posterior  measurement 
between  the  central  incisors  at  a  point  intersecting  a  vertical 
line  dropped  from  the  posterior  nasal  spine  to  the  posterior 
border  of  the  palate  bone.  The  height  of  vault  was  taken 
from  a  horizontal  line  extending  from  the  alveolar  process  on 
one  side  to  the  alveolar  process  on  the  oposite  side,  just  back 
of  the  second  bicuspid  teeth. 

The  following  measurements  were  taken: 


THE    HEAD,    FACE,    JAWS   AND    TEETH 


93 


NO. 

LATEHAL, 

ANTEEO-POSTEHIOH. 

HEIGHT  OF  VAULT. 

1. 

2. 
3. 
4. 
5. 
6. 

1.31  In.  =  33.22  Mm. 
1.25    "    =  31.75     " 
1.37    "    =  34.79     " 
1.56    "    =  39.51      " 
1.62    "    =  41.12      " 
1.25    "    =  31.75      " 

2        In.  =  50.80   Mm. 
2.12    "    =  53.84      " 
2          "    =:  50.80     " 
2.37    "    =  60.70      " 
2.25    "    =  57.15      " 
2.12    "    =  53.84     " 

0.37  In.  =     9.42   Mm. 
0.62    "    =  15.74     " 
0.43    "    -  10.92      " 
0.75    "    =  19.05      " 
0.50    "    =  15.24      " 
0.31    "    =     7.87      " 

Nos.  1  and  5  possess  very  much  the  same  contour  of  the 
dental  arch,  while  Nos.  4  and  6  are  very  broad,  with  square 
dental  arches. 

The  heights  of  the  vaults  are  all  different,  although  two 
are  flat,  while  the  others  are  more  or  less  rounding.  If  I  were 
to  hand  you  any  one  of  these  skulls,  and  ask  if  it  was  a  nor- 
mal vault,  you  would  most  likely  answer  yes.  Yet  all  are 
normal,  as  I  view  them,  while  no  two  are  alike. 

I  have  examined  hundreds  of  plaster  casts,  where  the  teeth 
were  all  in  a  fairly  normal  position,  with  similar  results. 

Of  372  skulls  of  Peruvians,  California  Indians,  Mound 
Builders,  and  American  Indians,  the  lateral  measurement 
varied  from  1.12  to  1.75,  and  the  antero-posterior  from  1.75 
to  2.75,  while  the  height  of  the  vault  varied  from  .24  to  .75. 

Oakley  Cole  made  careful  measurement  of  a  number  of 
skulls,  chiefly  in  the  museum  of  the  College  of  Surgeons, 
London,  England.  The  skulls  examined  fall  into  two  series, 
viz.:  those  of  European  origin,  and  those  of  mixed  races, 
with  the  following  results: 

EXAMINATION    OF   THIRTY-FOUR   EUROPEAN    SKULLS. 


LENGTH  IN 
MILLIMETERS. 

WIDTH  IN 
MILLIMETERS. 

HEIGHT  IN 
MILLIMETERS. 

Maximum .... 

58 
40 
49 

42 

31 

*35 

15 

Minimum 

Average 

*9 

EXAMINATION    OF   THIRTY-TWO   MIXED    SKULLS. 

LENGTH  IN 
MILLIMETERS. 

WIDTH  IN 
MILLIMETERS. 

HEIGHT  IN 
MILLIMETERS. 

Maximum 

65 
43 
54.9 

40 
29 

*35 

18 

Minimum 

6 

Average 

*12 

*  Taken  at  second  bicuspid. 


94  .  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

In  each  of  the  cases  that  I  have  examined,  the  dental  arch 
was  in  a  normal  condition.  I  have  also  examined  the  skulls 
mentioned  by  Oakley  Coles,  and  I  have  been  unable  to  find 
but  few  contracted  arches  in  any  of  them.  If,  therefore,  in 
the  examination  of  thousands  of  skulls  having  normal  dental 
arches,  no  two  vaults  are  found  to  correspond,  we  must  con- 
clude that  a  normal  vault  is  one  where  the  dental  arch  is 
regular,  and  the  different  outlines  possess  graceful  curves, 
regardless  of  height,  width  and  length. 

BY    WHAT    STANDARD    SHALL    WE    MEASURE    THE    VAULT? 

The  width  of  the  vault  depends  upon  two  factors:  First, 
the  development  of  the  jaw  bone  proper,  and,  second^  upon 
the  development  of  the  alveolar  process. 

Narrow  jaws  are  rarely  observed  among  the  early  races 
or  modern  pure  races.  In  the  examination  of  the  thousands 
of  skulls  of  early  races  in  the  museums  of  Europe  and  this 
country,  very  few,  if  any,  contracted  vaults  are  found.  This 
is  also  true  of  people  who  lead  a  quiet  life,  as  illustrated  in 
modern  pure  races.  If  the  brain  is  in  a  healthy  condition 
and  the  child  properly  nourished,  the  jaw-bone  will  develop 
in  size  sufficiently  to  accommodate  all  the  teeth  when  they 
erupt.  The  teeth  will  crowd  against  one  another  as  they 
come  into  place,  and  a  normal  width  of  arch  will  be  pro- 
duced. If  the  brain  is  defective,  as  the  result  of  some  of  the 
constitutional  diseases,  and  the  jaw  becomes  arrested  in  its 
development  just  before  sufficient  room  had  been  secured  for 
the  teeth,  they  will  crowd  against  one  another,  the  arch  will 
become  broken,  and  the  V  or  saddle  arch,  or  some  of  their 
modifications,  will  be  formed;  hence  a  narrow,  contracted 
vault.  The  amount  of  contraction  depends  upon  the  size  of 
the  jaw-bone  proper;  if  the  bone  has  become  arrested  early, 
the  jaw  being  small,  the  contraction  is  usually  very  great. 
The  alveolar  process  depends  entirely  upon  the  location  of 
the  teeth  for  its  shape  and  size.  Occasionally  the  teeth, 
which  are  small,  are  inherited  from  one  parent,  and  the  jaw- 
bone proper,  which  is  large,  from  the  other  parent.  In  such 
cases  the  alveolar  process  will  contract  until  all  the  teeth 


THE    ilEAD,    FACE,    JAWS    AND    TEETH  95 

antagonize,  when  a  small  arch  will  be  produced.  It  has 
already  been  shown  that  the  V  and  saddle  shape  arches  and 
their  modifications  are  observed  as  often  among  low  vaults  as 
among  high  ones;  just  as  we  have  seen  high  and  low  vaults 
in  normal  jaws.  The  contraction  is  duo  to  arrest  of  develop- 
ment of  the  jaw  at  the  time  of  the  eruption  of  the  permanent 
teeth;  the  vault  may  be  high  or  low.  What  appears  to  be  a 
high  vault  is  not  in  the  height  of  the  vault,  but  in  the  width. 
Having  now  explained  the  true  cause  of  what  appears  to  be  a 
high  vault,  if  we  will  refer  to  Clouston's  classification,  we 
will  find  what  he  calls  neurotic  and  deformed  are  both  one 
and  the  same.  Both  are  neurotic,  but  one  is  more  contracted 
than  the  other;  both  are  due  to  arrest  of  development  of 
the  maxillary  bones.  In  summing  up  our  observation,  we 
find  that  there  are  high  and  low  vaults  among  the  ignorant 
as  well  as  the  intellectual,  among  the  colored  as  well  as  the 
white,  among  the  brachycephalic  and  mesocephalic  as  much 
as  among  the  dolichocephalic,  among  the  deformed,  or  con- 
tracted, as  much  as  among  the  normal.  The  width  of  the 
vault  depends  upon  the  development  of  the  maxillary  bones; 
if  it  develops  to  a  size  sufficient  to  accommodate  all  the  per- 
manent teeth,  it  will  be  a  normal  vault,  regardless  of  height. 
On  the  other  hand,  if  arrest  of  development  of  the  jaw  takes 
place,  these  deformities  result  in  a  V  or  saddle  arch  or  some 
of  their  modifications.  How,  then,  shall  we  classify  vaults  ? 
In  the  measurement  of  the  height  of  vaults  of  8, 654  ancient 
and  modern  skulls  in  this  country  and  Europe,  the  highest 
was  .88,  the  lowest,  .25,  with  an  average  .53.  In  the  meas- 
urement of  6,387  mouths  of  living  people  over  twenty  years 
of  age,  the  highest  is  .8'i,  the  lowest  .21,  with  an  average  of 
.58.  In  the  measurement  of  6 16  insane  people  at  the  East- 
ern Illinois  Insane  Asylum,  the  highest  is  1,  lowest  .12,  with 
an  average  of  .  54. 

Taking  these  figures  into  consideration,  it  is  safe  to  aver- 
age  the  height  at  .55.  Allowing  .15  of  an  inch  in  each  direc- 
tion, we  can  call  vaults  which  measure  below  .40  low  vaults: 
those  between  .40  and  .70,  medium  vaults;  those  above  .70, 
high  vaults.       We  could  still  classify  those  below  .25  very 


96  .     ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

low  vaults,    and  those   above  .85  very  high  vaults.      The 
width  of  vault  between  second  bicuspids 
In  8,654  ancient  and  modern  skulls: 

Maximum,     -  -  -  -  1.63 

Minimum,  -  -  -     1.13 

Average,         -  -  -  -  1.36 

In  6,387  mouths  of  living  people  over  twenty 
years  of  age: 
Maximum,      -  -  -  -  1.50 

Minimum,  -  -  -  -        .93 

Average,  .      -  -  -  -  1.19 

In  616  insane  people: 

Maximum,      -  -  -  -  1.87 

Minimum,  -  -  -  -         .75 

Average,        -  -  -  -  1.16 

The  vast  difference  in  the  ancient  and  modern  skulls  of 

this  country  and  Europe,  with  those  of  living  individuals, 

shows  conclusively  that  the  jaws  are  diminishing  in  size. 

We  must,  therefore,  arrange  a  standard  by  which  we  are  to 

compare   the  width  of   the  vault  as  we  find  them   today, 

excluding  measurements  of   ancient  and  modern  skulls  and 

deformed  jaws.      Taking  the  1.19  as  the  average  width  of 

vault,  we  will  say  that  any  jaw  below   1  is  a  narrow  vault; 

one    between   1   and  1.40  medium   width,    and   one   which 

measures  above  1.40  a  wide  vault. 


CHAPTER  VIII. 

DEVELOPMENT  OF  THE  ALVEOLAR  PROCESS. 

The  alveolar  processes  are  situated  upon  the  superior 
border  of  the  inferior  maxilla  and  upon  the  inferior  border  of 
the  superior  maxilla.  These  bones  are  considered  a  part  of 
the  maxillary  bones,  and  are  so  described  by  anatomists. 
They  should,  however,  be  considered  and  described  as  prac- 
tically separate  and  distinct  bones.  Their  structure  and 
functions  differ  so  completely  from  the  structure  and  func- 
tions of  the  maxillary  bones  that  there  is  little  or  no  simi- 
larity between  them.  The  superior  and  inferior  maxillae  are 
(unlike  the  alveolar  processes)  composed  of  hard,  compact 
bone-structure.  The  large,  powerful  muscles  attached  to 
them  would  indicate  that  powerful  work  is  to  be  accom- 
plished, and  when  fully  developed  they  retain  their  full  size 
through  life.  The  alveolar  processes  are  composed  of  soft 
and  spongy  bone  of  a  relatively  cancellous  structure.  As 
early  as  the  eleventh  week  of  intra-uterine  life,  calcification 
of  the  deciduous  teeth  commences,  and  by  the  twentieth 
week  calcific  material  is  quite  abundantly  deposited.  Ossi- 
fication is  also  rapidly  progressing  about  the  dental  follicles. 
At  birth  the  sacs  are  nearly  or  quite  enclosed  in  their  soft, 
bony  crypts,  and  the  crowns  of  the  teeth  upon  their  outer 
surface  are  composed  of  enamel,  which  is  dense  and  hard. 

The  alveolar  process,  being  soft  and  spongy,  molds  itself 
about  the  sacs  containing  the  crowns  of  the  teeth  and  about 
their  roots  after  their  eruption,  regardless  of  their  position 
in  the  jaw.  While  the  alveolar  processes  have  grown  rapidly, 
they  have,  up  to  this  time,  developed  only  sufficiently  to 
cover  and  protect  the  follicles  while  calcification  proceeds. 
When  the  crowns  have  become  calcified  and  the  roots  have 
begun  to  take  in  their  calcific  material,  absorption  of  the 
borders  of  the  processes  takes  place  in  the  order  of  the  erup- 
tion of  the  teeth.  When  the  teeth  have  erupted,  the  alveolar 
process  develops  with  the  teeth  until  they  attain  the  depth 

97 


98     ■  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

of  the  roots  of  the  teeth,  which  extend  in  most  instances  into 
the  superior  maxillary  bone,  in  the  anterior  part  of  the  mouth 
at  least.  The  depth  to  which  they  penetrate  the  bone  differs 
in  different  mouths.  The  incince  fossa^  the  canine  eminence 
and  the  canine  fossa  give  evidence  of  this  externally.  These 
sockets  are  lined  with  extensions  of  the  process,  thus  making 
its  upper  border  irregular.  The  fact  that  some  of  the  teeth 
are  fixed  in  the  bone  as  well  as  in  the  alveolar  process  makes 
the  correction  of  some  forms  of  irregularity  more  difficult, 
for  not  only  does  the  process  have  to  be  reshaped,  but  the 
bone  as  well.  This  is  quite  noticeable  in  correcting  irregu- 
larities of  the  teeth  in  the  lower  maxilla.  The  crypts  of  the 
permanent  teeth  are  located  at  the  apices  of  the  roots  of  the 
temporary  teeth.     The  permanent  teeth  have  large  crowns 


Fig.  20. 

which  touch  each  other,  forming  a  line  to  the  posterior  part 
of  the  jaw.  These  teeth,  as  they  erupt,  entirely  absorb  the 
alveolar  process  which  surrounded  the  temporary  teeth,  and, 
as  the  new  set  come  into  place,  a  new  process  is  built  up 
about  them  for  their  support.  The  permanent  teeth  require 
a  deeper  alveolar  process  to  support  their  roots,  which  are 
much  longer  than  those  of  the  temporary  teeth.  Hence  the 
difference  in  the  depth  ol  the  arches  of  the  first  and  second 
sets  of  teeth. 

The  alveolar  process  of  each  superior  maxilla  includes  the 
tuberosity,  and  extends  as  far  forward  as  the  median  line  of 
the  bone,  where  it  articulates  with  the  process  upon  the 
opposite  side.  It  is  narrow  in  front,  and  gradually  enlarges 
until  it  reaches  the  tuberosity,  where  it  becomes  rounded. 

If   we  examine  the  two  articulated   superior  maxillary 


THE  HEAD,  FACE,  JAWS  AND  TEETH  99 

bones  (Fig.  20),  we  see  that  the  anterior  part  is  curved,  while 
the  posterior  part  gradually  diverges  from  the  central  line  of 
ossification  of  the  maxillary  bones.  The  shape  varies  in  dif- 
ferent individuals.  Some  arches  are  small  and  others  large; 
the  arch  is  parabolic  in  some  cases  and  circular  in  others. 

The  process  is  composed  of  two  plates  of  bones,  an  outer 
and  an  inner,  which  are  united  at  intervals  by  septa  of  can- 
cellous tissue.  These  form  the  alveoli  for  the  reception  of 
the  roots  of  the  teeth.  In  some  cases  the  buccal  surfaces  of 
the  roots  of  healthy  teeth  extend  nearly  or  quite  through  the 
outer  body  plate. 

This  plate  is  continuous  with  the  facial  and  zygomatic 
surfaces  of  the  maxillary  bone.  The  inner  plate  is  thicker 
and  stronger  than  the  outer,  and  is  fortified  by  the  palate 
bones.  The  external  plate  is  irregular  upon  the  outer  sur- 
face, prominent  over  the  roots  of  the  teeth,  and  depressed 
between  the  roots  or  interspaces. 

The  prominence  over  the  canine  teeth,  called  the  canine 
eminence,  is  very  marked,  and  decidedly  modifies  the  expres- 
sion of  the  face.  The  sockets  of  the  central  incisors  are 
conical  and  round;  those  of  the  lateral  incisors  conical  and 
slightly  flattened  upon  their  mesial  and  distal  surfaces,  and 
not  so  large  as  the  central  sockets. 

The  pit  for  the  cuspid  is  conical  and  much  larger  than 
any  of  the  other  sockets.  The  sockets  for  the  bicuspids  are 
flattened  upon  their  anterior  and  posterior  surfaces,  and  near 
the  apex  they  are  frequently  bifurcated.  The  sockets  of  the 
molars  are  large  at  the  openings,  but  at  about  the  middle  of 
their  length  they  are  divided  into  three  smaller  sockets  for 
the  reception  of  the  roots.  In  the  case  of  the  third  molar 
the  number  of  sockets  ranges  from  one  large  cavity  to  three 
or  four  of  smaller  size. 

THE    INFERIOR   ALVEOLAR   PROCESS. 

The  alveolar  process  of  the  inferior  maxilla  extends  from 
the  ramus  of  one  side  to  the  same  point  on  the  other.  The 
outline  is  similar  to  that  of  the  superior  process,  the  anterior 
portion  being  much  thinner. 


100  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

The  description  given  of  the  structure  of  the  superior 
process  will  also  apply  to  the  inferior.  The  outer  plate  of 
bone  opposite  to  the  molars  and  bicuspids  is  thicker  than  the 
inner  plate,  while  the  inner  plate  opposite  the  canines  and 
incisors  is  thicker  than  the  outer. 

The  alveoli  are  arranged  along  the  border  of  the  bone  for 
the  reception  of  the  roots  of  the  teeth.  They  correspond  in 
form  to  the  roots  which  they  accommodate.  The  alveoli  for 
the  central  incisors  are  smaller  than  those  for  the  lateral. 
They  are  conical  in  shape,  and  flattened  upon  their  mesial 
and  distal  surfaces.  Those  for  the  lateral  incisors  are 
larger,  and  compressed  on  their  mesial  and  distal  surfaces. 
The  sockets  for  the  canines  (cuspids,  or  stomach  teeth)  are 
larger,  deeper  and  less  compressed  than  those  for  the  incisors. 

The  sockets  of  the  bicuspids  are  considerably  flattened 
upon  their  lateral  surfaces,  and  are  sometimes  divided  into 
two  cavities.  The  sockets  for  the  anterior  roots  of  the  molars 
are  broad  and  flattened  laterally,  while  those  for  the  posterior 
roots  are  round.  The  third  molar,  being  naturally  of  varia- 
ble form,  has  sometimes  one  pit,  and  again  three  or  four. 
Each  alveolar  pit  or  socket  is  divided  from  its  neighbor  by  a 
small  wall  or  septum,  which  is  made  up  of  cancellated  bone, 
extending  about  one-eighth  of  an  inch  above  the  inner  and 
outer  plate. 

The  dental  septa  assist  in  keeping  the  teeth  firmly  in  their 
places. 

It  will  be  observed  that  the  septa  are  very  thin  at  the 
margin,  and  gradually  increase  in  width  to  the  middle  of  the 
jaw,  where  they  become  thicker,  and  are  finally  lost  in  the 
substance  of  the  jaw.  Some  septa  are  thicker  than  others, 
and  where  two  teeth  are  widely  separated,  the  width  of  the 
septa  naturally  corresponds  to  the  space  between  the  teeth. 

The  sockets  are  lined  with  a  thin  plate  of  compact  bony 
substance,  extending  from  the  outer  and  inner  plate  of  the 
alveolar  process  to  the  apex,  where  there  are  small  openings 
for  the  entrance  of  nerve  and  blood-vessels  for  the  nourish- 
ment of  the  teeth. 

This  bony  plate  has  upon  its  inner  surface  the  elastic  peri- 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


101 


dental  membrane,  which  acts  as  a  cushion  for  the  teeth, 
while  upon  the  inner  surface  it  is  surrounded  by  spongy 
bone. 

The  teeth  are  held  firm  in  their  alveolar  sockets  by  a  union 
called  gomphosis,  which  resembles  the  attachment  of  a  nail 
in  a  board.  Teeth  with  one  conical  root,  and  those  with  two 
or  more  perpendicular  roots,  are  retained  in  position  by  an 
exact  adaptation  of  the  tissues.  Teeth  having  more  than  one 
root,  and  those  bent  or  irregular,  receive  support  from  all 
sides  by  reason  of  their  irregularity.    The  teeth  are  also  held 


Pig.  21 


in  position  by  the  peridental  membranes.  Fig.  21  illustrates 
the  position  of  the  teeth  in  the  jaws.  The  peridental  mem- 
brane lines  the  alveolus  and  covers  the  roots  of  the  teeth.  It 
is  a  fibrous  tissue,  which  admits  of  a  slight  motion  of  the 
teeth,  and  acts  as  a  cushion  to  protect  the  jaws  from  severe 
blows  and  concussions  while  in  the  act  of  tearing  and  grind- 
ing food. 

After  the  removal  of  the  permanent  teeth  the  alveolar  pro- 
cess is  entirely  absorbed.  Fig.  22  shows  how  absorption  takes 
place.  The  teeth  have  all  been  removed  from  the  superior 
maxilla,  as  has  also  the  alveolar  process.  The  molars  on  the 
lower  jaw  have  been  extracted,  and  absorption  of  the  alveolar 


102 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 


process  has  resulted,  showing  a  marked  contrast  in  connec- 
tion with  the  anterior  alveolar  process,  which  remains  intact 
and  holds  the  teeth  lirmly  in  place.  Thus  it  will  be  observed, 
from  the  changes  which  occur  from  the  first  development  of 
the  teeth  to  their  final  extraction,  that  the  alveolar  process  is 
solely  for  the  purpose  of  protecting  the  teeth  in  their  crypts 
during  their  development  and  after  their  eruption.  When  the 
temporary  teeth  are  in  place  the  alveolar  process  remains 
unchanged  (except  a  gradual  enlargement  in  harmony  with 
the  growth  of  the  maxillary  bones)  until  about  the  sixth  year, 
when  the  second  set  of  teeth  appears.     The  crowns  of  the 


Fig.  22. 

permanent  teeth  require  more  space  than  those  of  the  tem- 
porary set;  and  the  alveolar  process  must  necessarily  enlarge 
to  accommodate  them.  This  enlargement  of  the  alveolar  pro- 
cess is  doubtless  caused  by  the  formation  of  the  crowns  of  the 
permanent  teeth  before  eruption,  and  to  a  limited  extent  by  the 
growth  of  the  maxillary  bones,  which  may  cease  developing 
at  any  period  in  the  life  of  the  individual,  or  continue  as  late 
as  the  thirty-sixth  year.  The  diameter  of  the  crowns  of  the 
permanent  teeth  forming  a  larger  circle  than  that  of  the 
maxillary  bones,  the  alveolar  process  must  necessarily  increase 
its  diameter.  It  is  often  forced  outside  of  the  superior 
maxilla  by  the  crowns  of  the  permanent  teeth  crowding  and 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


103 


wedging  themselves  into  positions  anterior  to  the  first  per- 
manent molar  teeth.  This  enlargement  of  the  alveolar  pro- 
cess usually  takes  place  anterior  to  the  first  permanent  molars. 
We  expect  to  find  the  process  corresponding  in  size  to  the 
jaws.  Fig.  23  shows  a  comparatively  small  superior  maxilla, 
the  inferior  being  much  larger.  This  is  the  result  of  arrested 
development,  including  the  bones  of  the  face.  To  allow  for 
the  deficiency  in  bone-structure,  and  allow  the  upper  teeth  to 
extend  over  the  lower,  the  upper  teeth  have  forced  the  alve- 
olar process  forward.  The  space  shows  where  a  tooth  was 
extracted  after  all  the  teeth  were  in  position.     The  teeth  of 


Fig.  23. 

today  are  nearly  if  not  quite  the  size  they  were  3,000  years 
ago;  on  the  other  hand,  the  jaws  are  growing  smaller.  To 
compensate  for  this  difference,  the  alveolar  process  has  to 
expand,  or  enlarge,  to  allow  the  teeth  to  come  in  evenly.  If 
the  teeth  antagonize  uniformly  the  arch  will  enlarge  around 
evenly.  If  the  molars  are  fixed  the  alveolar  process  will 
expand  anteriorly.  Again,  if  the  teeth  should  not  antagonize 
evenly,  a  break  will  take  place  at  that  point,  producing  a 
V  or  saddle  arch. 

Fig.  22  shows  a  similar  case  where  all  the  upper  teeth  have 
been  removed  and  absorption  has  entirely  obliterated  the 
alveolar  process.     The   relations  of  the  superior  maxillary 


101 


ETIOLOGY   OF   OSSEOUS   DEFORMITIES  OF 


bones  to  the  alveolar  process  and  teeth  on  the  lower  jaw  are 
well  illustrated.  When  the  alveolar  process  and  teeth  were 
intact  they  presented  an  appearance  like  illustration  No.  23. 
The  position  and  shape  of  the  processes  and  their  relation 
to  each  other  are  governed  entirely  by  the  location  and  size 
of  the  teeth  and  roots,  and  not  by  the  shape  of  the  jaw-bone 
proper.  The  dental  follicles  containing  the  crowns  may  be 
located  upon  the  outer  border  of  the  jaw-bone  on  one  side,  in 
which  case  the  alveolar  process  will  be  situated  upon  the 
outer  border,  and  assume  an  irregular  arch.  If  the  crowns 
of  the  teeth  are  located  upon  the  inner  border,  or  if  one  jaw 
be  smaller  than  the  other,  the  teeth  will  articulate   and  the 


Fig.  24. 

process  will  form  a  smaller  circle  than  the  jaw-bone  proper. 
Such  a  case  is  illustrated  in  Fig.  2i.  The  superior  maxilla 
is  much  larger  than  the  inferior,  and,  as  a  result,  the  articula- 
tion of  the  teeth  and  the  muscles  of  the  cheeks  and  lips  have 
carried  the  teeth  and  alveolar  process  on  the  upper  jaw 
inward.  The  teeth  on  the  lower  jaw  are  regular  and  appear 
to  have  sufficient  room,  while  those  upon  the  upper  ja\\  are 
crowded  and  overlap  each  other.  The  teeth  on  the  left  side 
of  the  upper  jaw  are  more  regular  than  those  on  the  right 
side.  Upon  examining  the  mouth,  or  model,  the  arch  on  the 
left  side  will  be  found  full  and  regular,  while  the  arch  upon 
the  right  side  has  a  perfect  semi-V-shape. 

The  alveolar  process  on  the  right  side  extends  considera- 


THE    HEAD,    FACE,    JAWS   AND    TEETH 


105 


bly  over  the  border  of  the  maxillary  bone,  and  the  teeth 
(especially  the  cuspid)  have  taken  quite  an  incline  in  order  to 
articulate  with  the  teeth  upon  the  lower  jaw,  thus  crowding 
the  alveolar  process  to  the  inner  border  of  the  maxillary 
bones. 

The  process  is  solely  for  retaining  the  teeth,  and  if  for 
any  reason  the  dental  follicles  should  not  be  present  and  the 
tooth  should  not  erupt,  or  if  it  should  have  been  extracted 
early,  the  process  would  not  be  developed  at  that  point.  In 
ray  collection  of  models  may  be  seen  cases  of  arrested  develop- 
ment of  the  alveolar  process,  caused  by  the  lack  of  bicuspid 
and  lateral  incisor  germs,  and  by  the  extraction  of  the  decid- 
uous and  permanent  teeth. 


Pig.  25. 


If  one  or  more  teeth  should  not  antagonize,  the  alveolar 
process  would  extend  beyond  the  natural  border,  carrying 
the  teeth  with  it,  A  marked  illustration  of  this  is  seen  where 
the  molars  are  decayed  to  the  gum  and  the  roots  remain. 
The  vascularity  of  the  process  is  such  that  its  development 
results.  Excessive  development  of  the  alveolar  process  is 
frequently  observed  by  every  practitioner  in  connection  with 
the  anterior  inferior  teeth.  When  the  articulation  is  normal, 
occlusion  of  these  teeth  never  takes  place.  We  frequently 
find  (especially  in  patients  from  six  to  twelve  years  of  age) 
these  teeth  extending  to  and  occluding  with  the  mucous 
membrane  of  the  hard  palate,  making  one  of  the  most  diffi- 
cult forms  of   irregfularities  to  correct.       Such  a  case  is  illus- 


106  ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 

trated  in  Fig.  25.  This  model  is  taken  from  the  jaw  of  a 
person  thirty-seven  years  of  age,  but  I  venture  the  statement 
that  this  excessive  development  took  place  between  the  ages 
of  six  and  twelve,  because  at  that  period  the  vascularity  of 
the  tissues  is  more  vigorous  and  the  development  of  the  pro- 
cess more  formative  than  at  any  period  subsequent  to  the 
development  of  the  first  permanent  teeth. 

I  recall  a  case  in  practice  in  which  the  incisors  and  cuspids, 
together  with  their  alveolar  process,  were  situated  upon  the 
external  surface,  while  the  bicuspids,  molars  and  their 
alveolar  process  are  located  upon  the  inner  border  of  the  jaw. 
Another  case  is  one  in  which  the  alveolar  process  failed  to 
cover  the  roots  of  the  bicuspids  and  molars  upon  the  outer 
surface,  the  teeth  having  forced  themselves  into  a  larger  cir- 
cle through  the  alveolar  process  by  the  contact  of  the  crowns. 
The  roots  in  this  case  can  be  easily  outlined  by  the  finger 
through  the  mucous  membrane;  the  outer  plate  of  the 
alveolar  process  barely,  if  at  all,  covering  them.  Mr.  Tomes 
mentions  and  illustrates  a  case  in  a  late  work,  of  faulty  develop- 
ment of  the  outer  plate  of  the  alveolar  process  exposing 
the  crowns  of  all  the  temporary  teeth.  The  case  was  a  child 
who  had  suflered  from  hydrocephalus.  I  have  a  number  of 
models  showing  the  anterior  alveolar  process  projecting 
beyond  the  normal  position  by  the  forward  movement  of  the 
molars.  This  may  be  due  to  a  natural  movement  of  Ihe 
molars  forward,  or  the  process  may  be  forced  forward  by  the 
improper  occlusion  of  the  jaws.  The  teeth  are  moved  from 
one  position  to  another  simply  by  the  force  consequent  upon 
absorption  and  deposition  of  bone.  This  is  noticeable  in  the 
spaces  between  the  centrals,  when  the  alveolar  process 
develops  to  a  larger  circle  than  is  necessary  to  accommodate 
the  teeth.  The  alveolar  processes  are  influenced  in  one  direction 
or  the  other  by  the  pressure  of  articulation.  This  abnormal 
condition  is  the  result  of  inharmonious  development  of  the 
jaws.  The  teeth  may  come  together  in  such  a  manner  as  to 
throw  the  alveolar  processes  either  to  the  right  or  left,  thus 
producing  a  full  round  arch  upon  one  side  of  the  jaws  and  a 
perfectly  flat  or  straight  arch  upon  the  other.     (See  Fig.  24.) 


THE    HEAD,    FACE,    JAWS    AND   TEETH  107 

The  greatest  deformity  is  that  in  which  the  teeth  of  the  upper 
jaw  and  alveolar  process  are  forced  forward,  causing  a  pro- 
trusion of  the  anterior  superior  part  of  the  mouth.  Occa- 
sionally we  find  both  upper  and  lower  alveolar  processes  car- 
ried forward  in  the  same  manner.  The  alveolar  process  upon 
the  lower  jaw  is  more  liable  to  be  found  upon  the  inner  bor- 
der of  the  jaw  than  is  the  upper  alveolar  process,  as  the 
inferior  maxilla  is  larger  and  more  dense  than  the  superior, 
and  when  the  teeth  are  once  in  position  upon  the  lower  jaw 
they  are  not  liable  to  subsequent  change.  As  the  jaws 
become  smaller  and  more  delicate,  the  anterior  alveolar  pro- 
cess becomes  thinner  and  less  liable  to  resist  the  forward 
movement  of  the  molar  and  cuspid  teeth,  thus  producing  ante- 
rior protrusion  and  V-shaped  irregularities.  Owing  to  this 
fact  the  teeth  of  the  superior  maxilla  do  not  form  so  great  a 
circle,  causing  the  teeth  upon  the  sides  of  the  jaws  to  conflict 
and  the  lower  teeth  and  alveolar  processes  to  be  carried  in? 
While  the  anterior  teeth  of  the  lower  jaw  are  held  inside  of 
the  superior  anterior  teeth,  thus  carrying  the  alveolar  pro- 
cess inward. 

The  teeth  are  continually  changing  their  positions  in  the 
mouth.  This  is  beneficial  as  often  as  it  is  detrimental.  That 
the  teeth  may  perform  their  full  function,  they  should  not 
only  remain  firmly  fixed  in  the  alveolar  process,  but  they  should 
also  antagonize.  The  teeth  may  be  compared  to  the  bricks 
in  an  arch;  remove  a  brick  and  the  arch  falls  to  pieces. 
It  is  frequently  found  that  the  teeth  do  not  articulate  prop- 
erly, and  by  cutting  away  the  approximal  surfaces  a  better 
articulation  may  be  secured.  When  this  operation  is  per- 
formed the  teeth  move  in  their  sockets  by  absorption  and 
deposition  of  bone,  demonstrating  the  fact  that  the  process 
changes  in  shape  and  substance. 

The  tendency  of  the  alveolar  process  to  develop  between 
the  sixth  and  twelfth  year  is  something  marvelous.  This 
seems  to  be  the  period  of  its  greatest  activity. 

Physiological  excessive  development,  however,  is  governed 
entirely  by  the  eruption  of  the  teeth.  The  air  passages  may 
become  filled  by  excessively  developed  bones  or  mucous  mem- 


lOS  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

brane,  by  adenoid  veoeiation  or  other  causes;  as  a  result 
mouth-breathing  will  take  place. 

The  lower  jaw  drops,  and  the  pressure  is  taken  away  from 
the  teeth. 

Inidioc3%  and  imbecility,  and  other  degenerate  conditions, 
mouth-breathing  is  also  very  common. 

In  these  cases  we  find  a  long,  thin  alveolar  process.  The 
teeth  continue  to  erupt,  and  the  alveolar  process  elongates. 

Occasionally  when  the  mouth  is  closed  the  six  anterior 
teeth  will  elongate,  and  the  lower  incisor  will  penetrate  the 
superior  alveolar  process. 

In  such  cases  the  superior  incisors  protrude  and  separate. 
This  deformity  will  continue  until  the  upper  incisors  cease  to 
develop,  owing  to  the  pressure  of  the  alveolar  process  upon 
the  lower  incisor  teeth. 

If,  now,  we  wish  to  correct  this  deformity  the  first  thing  to 
do  is  to  place  a  plate  in  the  mouth,  to  allow  the  lower 
incisors  to  rest  upon  the  plate. 

In  this  manner  the  pressure  is  taken  from  the  bicuspids 
and  molars.  In  two  or  three  weeks'  time  the  posterior  teeth 
and  alveolar  process  will  elongate  from  .12  to  .16  of  an  inch; 
thus  showing  the  possibility  of  the  development  of  the  alve- 
olar process  in  a  short  time  by  removing  the  pressure. 

In  some  cases  this  excessive  development  of  the  alveolar 
process  goes  on  very  rapidly,  especially  in  the  case  of 
an  epileptic. 

This,  however,  takes  place  at  the  time  of  the  development 
of  the  first  teeth. 

HYPERTROPHY  OF  THE  ALVEOLAR  PROCESS. 

From  what  has  already  been  said  of  the  vascularity  of  the 
alveolar  process,  we  may  expect  to  find  hypertrophy  of  the 
tissue  ensuing  from  simple  irritation  of  varying  degree.  The 
irritation  consequent  upon  the  eruption  of  the  teeth,  together 
with  the  excessive  blood-supply,  are  both  primal  causes  of 
over-building  of  tissue,  i.  <?.,  hyperplasia. 

The  ragged  roots  of  the  temporary  teeth,  produced  by 
absorption,  the  gases  from  the    putrescent   pulps,   and  the 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


109 


pressure  of  the  permanent  crowns  against  the  tissues,  produce 
sufficient  stimulation  to  excite  physiological  action.  Tissue- 
building  generally  is  seen  in  connection  with  the  teeth  pos- 
terior to  the  cuspid,  rather  than  with  the  teeth  anterior  to 
that  tooth.  It  seems  accountable  only  from  the  fact  that  the 
incisors  have  sharp  cutting-edges,  the  roots  of  the  teeth  are 
single  and  nearly  always  shed  before  the  permanent  teeth  are 
in  place,  and  they  erupt  at  an  age  when  there  is  less  vitality. 
Per  contra^  the  crowns  of  the  teeth  posterior  to  the  cuspid  are 
broad  ^  the  roots  of  the  temporary  teeth  posterior  to  the 
cuspids  are  more  numerous  than  those  anterior  to  them,  and, 
with  the  exception  of  the  first  permanent  molars,  they  erupt 


Fig.  26. 


at  the  age  of  greatest  vitality.  Epileptics  of  all  the  degene- 
rates are  the  class  who  possess  these  stigmata.  Excessive 
development  of  the  alveolar  process  is  unusually  common 
among  them,  as  is  also  the  case  with  the  muscles  of  the  body. 
The  process  becomes  unnaturally  thick,  the  bicuspids  and 
molars  are  carried  in  one  direction  and  another,  eifecting  a 
variety  of  irregularities.  I  have  frequently  observed  hyper- 
trophy in  connection  with  epilepsy.  This  is  owing  to  the 
unstable  tissue-building,  as  noticed  among  degenerates.  A 
common  form  is  shown  in  Fig.  26.  Similar  irregularities  are 
also  seen  in  Cole's  "Deformities  of  the  Mouth,"  Figs.  12,  13, 
and  27;  and  in  Tomes'  "Dental   Surgery,"  Fig.  90.     These 


110  ETIOLOGY   OF   OSSEOUS   DEFORMITIES 

deformities  till  take  the  contour  of  the  saddle-shaped  arch. 
This  may  be  accounted  for  from  the  fact  that  the  permanent 
molars,  being  the  first  teeth  to  erupt,  become  fixed  before 
the  deposit  commences.  The  crowns  of  the  bicuspids  are 
also  held  in  a  small  circle  by  the  retention  of  the  temporary 
molars.  When  these  teeth  do  not  antagonize  they  are  liable 
to  be  carried  inward. 

The  cuspids,  with  their  long  roots,  meet  resistance  either 
in  connection  with  the  teeth  adjoining  or  with  those  upon  the 
opposite  jaw,    and   are  thus  held   in    position.     It   will   be 


Fig.  27. 

observed  that,  in  all  of  these  cases,  the  enlargement  seems  to 
be  associated  with  the  inner  plate  of  the  alveolar  process. 
My  observation  in  these  cases  has  been  that  with  most  of 
them  the  inner  plate  is  the  part  of  the  alveolar  process 
affected.  The  outer  plate,  although  quite  irregular  from  the 
arrangement  of  the  teeth,  is  usually  normal  in  thickness. 
This  disparity  in  the  two  plates  of  the  alveolar  process  may 
be  accounted  for  from  the  fact  that  the  inner  plate  of  the 
alveolar  process  possesses  a  large  blood-supply — the  posterior 
or  descending  palatine  arteries  furnishing  the  ossific  material. 
The  author  has  observed  a  few  cases  where  the  hypertrophy 


THE     HEAD,    FACE,    JAWS   AND   TEETH  111 

has  extended  to  and  included  the  outer  plate.  When  the 
outer  plate  becomes  involved  the  alveolar  process  assumes  a 
very  thick  condition.  Occasionally,  hypertrophy  will  affect 
one  side  only  or  one  distinct  locality.  Fig.  27  illustrates  such 
a  case.  In  this  case  the  enlargement  is  upon  the  left  side  and 
extends  from  the  first  bicuspid  posterior  to,  and  including, 
the  maxillary  tuberosity.  Instead  of  the  force  being  directed 
inward,  as  is  generally  the  case,  the  process  is  forced  out- 
ward and  backward.  This  enlargement  occurred  previous  to 
the  development  of  the  second  and  third  molars.  The  alve- 
olar process  extends  downward  and  occludes  with  the  teeth 
upon  the  lower  jaw,  thus  preventing  the  molars  from  erupting. 


CHAPTER  IX. 

DEVELOPMENTAL  NEUROSES. 

Dr.  Langdon  Down,  of  the  Earlsworth  Asjdum  (London), 
first  called  the  attention  of  the  profession,  in  1871,  to  the 
fact  that  after  observation  of  the  mouths  of  a  large  number 
of  congenital  idiots,  he  found  that  in  nearly  every  case  there 
was  a  contracted  arch  at  the  second  bicuspid  region  and  an 
inordinate  vaulting  of  the  palate,  and  that  irregularities  of 
the  teeth  were  very  common  among  this  class  of  patients. 
Dr.  W.  W.  Ireland,  in  confirming  this,  says  that  by  an  exam- 
ination of  the  mouths  of  eighty-one  congenital  idiots,  he  found 
tAvo  cases  of  cleft  palate  and  thirty-seven  deeply  vaulted,  keel 
shaped  palatine  arches.*  Dr.  Kingsley  examined  the  jaws  of 
200  idiots  on  Randall's  Island,  but  found  very  few  con- 
tracted arches  at  the  bicuspid  region,  and  no  case  of  pro- 
nounced V-shaped  arch.  Drs.  J.  W.  White  and  Stelwagen, 
after  an  examination  of  one  hundred  and  eighty- four  idiot 
children,  found  that  large  and  well-formed  jaws  were  the 
rule,  and  that  idiots  would  "compare  fair  in  this  respect 
with  the  same  number  of  similarly  neglected  people  of  ordi- 
nary intelligence."  Dr.  Kingsley  concludes  that  "  taking  the 
idiots  as  a  class  and  comparing  them  with  the  lower  order  of 
society,  as  found  in  this  country,  there  were  no  more  irregu- 
larities in  the  one  than  in  the  other." 

Such  seemingly  conflicting  reports  by  men  of  equal  abil- 
ity in  their  several  specialties  upon  both  sides  of  the  Atlantic, 
led  the  author  to  take  up  the  special  study  of  the  etiology  of  the 
deformities  of  the  jaws  and  teeth,  in  1881,  with  a  view  of 
obtaining  the  true  cause,  if  possible,  of  the  abnormal  condi- 
tions. This  desire  was  strengthened  by  the  fact  that  he  had 
observed,  like  Dr.  Kingsley,  marked  deformities  (but  per- 
haps not  so  many)  among  some  of  his  best  patients  (well-to- 
do  people),  and  bright  business  men  and  women.  It  was 
thought  best  to  examine  the  jaws  of  the  idiots  first  and  study 

— m 

*British  Oclontological  Society's  Trans.,  1871. 

112 


THE     HEAD,    FACE,    JAWS    AND    TEETH  113 

the  subject  from  that  standpoint.  The  result  of  this  investi- 
gation was  a  paper  read  before  the  International  Medical 
Congress,  held  in  Washington  in  1887,  in  which  it  is  noted 
that  only  55.3  per  cent,  of  all  the  inmates  of  the  asylum 
examined  possessed  normal  jaws.  Subsequent  study  and 
investigation  by  the  author  has  shown  that  all  defective 
classes  possess  an  unusually  large  number  of  deformities  of 
the  jaws  and  teeth,  and  a  little  later  he  published  in  The 
Dental  Cosmos  the  result  of  his  investigations.  It  now 
seemed  necessary  to  take  up  the  subject  of  the  development 
of  the  brain  and  its  diseases,  with  a  view  of  tracing  the  dif- 
ferent mental  conditions  of  those  suffering  with  deformities. 
An  oral  report  of  this  work  was  accepted  as  a  thesis  for 
admission  to  the  Chicago  Academy  of  Medicine,  in  1890. 
Before  taking  up  the  subject  in  detail,  a  paper  written  by 
Mr.  Cartwright,  bearing  upon  these  points,  will  furnish  a  suit- 
able text  for  some  remarks.  Mr.  Cartwright,  in  a  paper  read 
before  the  Odontological  Society  of  London,  May  2,  1864, 
among  other  things,  remarks:  "Irregularity  is  common  in  most 
highly  civilized  communities,  and  especially  so  among  the 
upper  and  middle  classes,  and  it  is  more  constant  among  the 
inhabitants  of  towns  than  it  is  among  the  inhabitants  of  agri- 
cultural districts.  *  "''  *  *  Now,  it  appears  to  me  to  be 
a  question  of  much  interest  and  importance  to  consider 
whether  the  form  and  size  of  the  jaws  in  civilized  countries, 
in  some  instances,  may  not  be  accounted  for  as  resulting  from 
a  process  of  breeding.  We  know  that  with  animals  and 
birds  what  is  called  high  breeding  is  arrived  at  and  main- 
tained by  the  constant  selection  of  birds  and  animals  possess- 
ing particular  points  and  characteristics;  and  Mr.  Darwin 
has  shown,  and  Mr.  Huxley  and  others  have  added  the 
weight  of  their  sanction  to  the  truth  of  Mr.  Darwin's  facts, 
that  with  birds — take  the  pigeon,  as  he  has,  as  an  example — 
by  selective  breeding  the  bones  as  well  as  the  plumage, 
become  altered,  and  changed  from  the  original  type.  *  *  -^ 
Thus,  we  may  reasonably  argue,  that  small  jaws  may 
be  characteristic  of  breed  in  certain  conditions  of  life,  or 
may  express  symptoms  of  deteriorated  growth,  under  some 


Ill  .  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF, 

circumstances  of  society.  And  whether  it  be  high  breeding, 
or  close  breeding  (I  mean  where  marriages  of  near  con- 
sanguinity occur  and  recur),  diminished  capacity  in  the  jaws 
is  generall}'  a  prominent  feature,  and  irregularities  of  the 
teeth  a  common  phase. 

"What  ccmstitutes  high  breeding?  Is  it  not  selective 
breeding  confined  principally  to  a  particular  class  or  classes  ? 
Take  the  aristocracy  and  families  who  date  their  names  and 
descent  from  antiquity,  who,  as  a  rule,  intermarry  among 
themselves,  from  political  or  family  reasons,  and  to  a  more 
modified  extent,  other  classes  of  the  community — modified 
because  they  represent  much  greater  numbers — and  I  am  con- 
vinced that  we  find,  as  a  result  of  that  selective  breeding, 
I)eculiarities  of  form  and  organization  not  differing  from 
what  we  find  to  be  the  case  with  high  breeding  among  ani- 
mals, which  is  maintained  by  the  constant  and  careful  selec- 
tion of  animals  possessing  particular  points  and  character- 
istics. Take  the  horse  and  consider  the  points  which  make 
up  a  thoroughbred  animal.  The  small  head  and  ears,  the 
thin  legs,  small  fetlocks  and  feet,  the  necks  and  bodies  finely 
and  symmetrically  proportioned,  and  then  the  narrowness  and 
comparative  smallness  of  the  maxilla?." 

Within  the  past  few  years  great  advancement  has  been 
made  in  difl'erentiating  the  various  forms  of  insanity,  but  even 
now  classification  is  admittedly  imperfect.  Patients  admitted 
to  public  and  private  insane  hospitals  do  not,  as  a  rule, 
bring  with  them  complete  and  reliable  data  as  to  the  causes 
of  their  malady.  While  the  attending  physicians  may  be 
generally  anxious  to  obtain  a  very  accurate  anamnesis  of  the 
case,  the  patients  and  relatives  are  loth  to  answer  questions, 
or  through  ignorance  are  unable  to  answer  them  correctly. 
In  public  institutions  especially,  it  is  often  impossible  to  get 
at  a  true  history  of  the  previous  condition  of  the  patient. 
Alienists  have,  however,  been  able  to  classify  certain  marked 
forms  of  insanity  and  degeneracy,  so  that  other  specialists 
can,  from  their  standpoints,  add  materially  to  knowledge 
already  obtained,  and  by  putting  together  the  different  frag- 
ments so  obtained,  eventually  derive  facts  of  scientific  value. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  115 

The  study  of  the  human  body  has  become  so  scientific  and  so 
complicated,  that  no  one  individual  can  grasp  the  whole,  but 
by  becoming  proficient  in  some  one  specialty,  he  can  add 
materially  in  solving  the  great  question  of  cause  by  adding 
his  mite  to  the  grand  total.  Alienists  have  divided  certain 
conditions  of  the  brain  into  two  great  classes — neurotics  and 
degenerates.  ^ 

A  neurotic  is  one  whose  .brain  and  nervous  system  (spinal 
and  peripheral  nerves  included)  are  unstable  from  acquired 
taint,  or  often  from  inherited  tendencies. 

A  degenerate  is  a  being  who  has  imperfectly  undergone 
the  changes  from  a  higher  to  a  lower  type  in  tissue  or  organs. 

Authors  and  specialists  differ  in  regard  to  these  defini- 
tions, and  also  differ  as  to  the  cases  that  should  come  under 
the  head  of  one  and  the  other.  The  inherited  element  in 
both  leads  to  this  confusion,  especially  as  the  neurotic  at 
most  has  often  but  latent  heredity. 

The  doctrine  of  degeneracy,  explanatory  of  these  condi- 
tions, may  be  tersely  stated  as  follows  :  There  are  local 
degeneracies  of  tissue  function,  but  this  is  not  the  sense  in 
which  the  term  is  used  by  the  disciples  of  Morel,  the  founder 
of  the  doctrine  of  human  degeneracy.  As  Morel  and  his 
later  disciples  have  shown,  alcoholism,  skull  fracture,  spinal 
diseases,  etc.,  in  the  ancestor  may  produce  an  hereditary 
taint  showing  degenerative  stigmata  in  the  child.  Degener- 
acy is  used  in  the  evolutionary  sense  as  impl^'ing  an  atavism, 
which  necessitated  at  least  two  generations.  The  doctrine  of 
evolution  is  that  everything  proceeds  from  a  simple  homo- 
geneous to  a  complex  heterogeneous  with  a  loss  of  expendi- 
ture of  force.  Thus,  in  the  nutritive  reversions,  a  tissue 
may,  by  degeneracy,  regain  a  power  of  reproduction  which 
it  had  in  the  foetal  state,  such  reproduction  extending  beyond 
mere  repair.  Vertebrates  never,  or  rarely,  reproduce  lost 
limbs,  while  the  phenomenon  is  far  from  infrequent  in 
invertebrates.  This  condition  of  degeneracy  underlies  cer- 
tain tumors;  reproduction  exceeding  a  required  rate  of 
repair.  Cohnheim  is  of  the  opinion  that  this  tendency  under- 
lies all  cancer  formation,  but  later  researches  somewhat  mod- 


116  ETIOLOGY   OF   OSSEOUS  DEFORMITIES   OF 

ify  this  view.  Degeneracy,  furthermore,  implies  a  hitent 
instability  of  tissue  which  constitutes  the  hereditary  predis- 
position to  disease  exemplified  in  neurotics,  as  well  as  other 
systemic  diseases.  All  these  may  present  stigmata  or  signs 
of  degeneracy;  most  frequent  and  numerous  in  the  intellect- 
ual and  ethical  atavism,  and  least  in  the  nutritive  atavisms, 
spinal  degeneracies  and  local  reversions.  The  nutritive  ata- 
visms may  appear  as  stigmata  in  the  other  types,  and  so  may 
the  spinal  and  local  reversions. 

Degeneracy  may  involve  the  entire  system,  or  only  a  part, 
or  merely  a  function  of  a  part.  Gout  is  the  reversion  of  a 
mammalian  liver  to  an  areptilian  function.  Degeneracy  may 
seem  to  be  acquired,  since  it  appears  only  at  the  periods  of 
involution,  or  at  the  periods  of  evolution,  but  the  degeneracy 
is  in  the  tissue  instability  present,  which  is  not  evoked  until 
the  epochs  of  stress  on  function.  Weissmann  denies  transmis- 
sion of  acquired  defect,  but  his  attempt  to  explain  hereditary 
epilepsy  on  any  other  theory  fails  completely.  He  charges 
epilepsy  to  microbes,  but  admits  that  it  may  be  produced  in 
the  fi.rst  generation  by  non-microbic  agencies.  There  is 
no  proof  existent  of  the  microbic  origin,  and  Weissmann's 
explanation  fails,  as  Eimer  has  shovvn. 

Weissmann,  however,  admits  (which  emphatically  settles 
the  question)  that  disturbances  of  the  nutrition  of  the  ovum 
may  cause  the  inheritance  of  acquired  defect.  He  there- 
fore admits  that  acquired  defects  suiEcient  to  affect  the  nutri- 
tion of   the  ovum  can  be  inherited. 

The  following  table  represents  the  views  of  the  lucid, 
logical  disciples  of  Morel: 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


117 


Spinal 


Ethical 
Degeneracy 


f  Crime. 

{   Prostitution  and  Sexual  Degen- 
~{       eracy. 

I   Moral  Insanity,  Pauperism  and 
[      Inebriety. 


Cerebral.      -{ 


Intellectual  Degeneracy. 

Paranoia. 

Adolescent  Insanity. 

Intellectual 
Degeneracy 

Periodical  Insanity. 
Hysteria. 
Epilepsy. 
Neurotics. 

Genius. 

Idiocy. 

Sensory         j  Deaf  Mutism. 
Degeneracy  1  Congenital  Blindness. 

'  Lymphoid  Degeneracy. 
Tissue  Instability. 

Nutritive 

Plural  Births. 

Degeneracy 

Bleeders. 

Excessive  Fecundity. 

Gout. 

Various  Congenital  and  Hereditary  Disorders. 


and  Allied  Male  States. 


Jaws. 

Cleft  Palate. 

Teeth. 

Primitive  Uteri, 

Cloacal  Conditions, 
Local  Horse-shoe  Kidney,  and  Allied  States. 

Reversional  -j  Cyclopian  Monstrosities. 
Tendencies.   |  ^^^^jjac  and  Polymeliac  States,  Club  Feet,  etc. 

Plural  Mammae. 

Simian  Muscular  and  Bony  States. 

Liver,  and  other  Orsfan  Reversion. 


118  ETIOLOGY   OF   OSSEOUS  DEFORMITIES 

As  a  result  of  defective  cerebral  and  spinal  development, 
we  have  three  great  classes  of  brain  degeneracies — ethical, 
intellectual  and  sensory — resulting  from  defective  nutritive 
and  local  deformities. 

Among  the  local  manifestations  which  seem  most  apt  to 
appear  as  stigmata,  owing  to  the  great  tendency  of  variation  in 
structure  of  the  body,  in  evolution,  are  those  in  the  cranium, 
nose,  face,  jaws  and  teeth.  The  author  does  not  mean,  how- 
ever, to  infer  that  other  parts  of  the  osseous  system  or  organs 
of  the  body  are  not  so  often  afiected  (indeed,  he  is  of  the 
opinion  that  they  are),  but  that  there  is  no  one  organ  or  part 
of  the  body  which  is  so  often  aflfected  as  these.  Thus,  as  we 
shall  see,  taking  a  given  disease  of  the  brain,  such  as  para- 
noia, epilepsy,  etc.,  from  seventy  to  ninety  per  cent  will 
possess  deformities  of  the  cranium,  face,  jaws  and  teeth ;  but 
it  would  not  be  possible  in  a  given  disease  to  find  seventy  to 
ninety  per  cent  of  primitive  uteri,  horse-shoe  kidneys,  or 
liver  reversion.  We  shall,  however,  in  almost  every  case, 
where  the  jaws  are  deformed,  find  some  one  or  more  of  the 
conditions  of  the  organs  or  tissues  of  the  body  named  under 
the  head  of  local  reversion.  We  shall  also  be  able  to  find  the 
missing  link  which  seems  to  unite  our  every-day  patients 
with  those  confined  in  our  public  and  private  asylums.  In 
order  to  accomplish  this  we  have  only  to  study  those  con- 
ditions which  come  under  the  head  of  cerebral  reversions, 
resulting  in  deformities  of  the  cranium,  nose,  face,  jaws  and 
teeth.  We  shall,  therefore,  take  up  each  subject  in  the  order  in 
which  they  appear  in  the  table,  and  see  what  relation  they  bear 
to  each  other  and  to  deformities  of  the  osseous  system  (the  part 
of  the  body  in  which  we  are  most  interested).  It  will  be  well, 
however,  before  doing  so,  to  give  the  reader  an  idea  of  what 
we  expect  to  find  beforehand,  so  that  he  will  be  able  to 
follow  each  case,  and  thereby  comprehend  the  results  as  the 
brain  presides  over  it.  If  the  brain  is  deformed  we  expect  to 
show  that  one  of  two  conditions  must  naturally  follow — 
excess  or  arrest  of  development — or  physiological  hyper- 
trophy and  atrophy,  and  not  pathological  hypertrophy  and 
atrophy,  as  the  terms  are  usually  used.  We  also  expect  to 
find  degeneracy  of  the  soft  tissues  as  well. 


CHAPTER  X. 

CRIME. 

According  to  Lombroso,  crime,  or  its  equivalent,  is  found 
among  the  lower  animals  and  some  fe>v  plants  as  Avell  as 
in  man,  but  in  man  it  assumes  a  more  serious  nature, 
from  the  fact  that  man  is  able  to  discriminate  between 
right  and  wrong.  This  discrimination,  however,  is  also 
found  among  some  of  the  higher  animals,  but  it  is  of  such  a 
modified  type  that  most  thinkers  are  inclined  to  call  it 
instinct.  There  are  only  a  few  species  of  what  might  be 
called  criminal  plants,  the  most  common  being  the  fly-trap, 
found  in  Southern  United  States.  Should  a  fly,  or  other 
insect,  happen  to  settle  upon  one  of  its  leaves,  it  is  certain 
death  to  the  insect,  for  no  sooner  than  it  alights,  the  leaves 
close,  holding  the  creature  firmly  until  its  small  life  has 
ended. 

Crime  in  animals,  however,  has  more  of  the  c(»nditions  of 
man.  In  the  animal,  we  find  conceit,  theft,  swindling,  lazi- 
ness, and  even  premeditated  crime.  The  habits  of  the  dog 
and  cat  for  theft  and  slyness  are  common  to  all;  generally, 
the  theft  is  to  appease  hunger,  and  not  confined  to  useless 
articles  so  characteristic  of  the  thefts  of  magpies,  crows,  rats 
and  monkeys.  This  latter  is  allied  to  the  element  of  klepto- 
mania so  common  in  man. 

Animals  are  conscious  of  their  own  deceit,  as  shown  by 
the  fact  that  they  operate  secretly  and  with  precautions  to 
avoid  discovery.  Thus  we  know  that  savage  animals  approach 
their  prey  as  noiselessly  as  possible,  and  if  discovered  before 
springing  steal  away  and  lie  in  wait  for  a  better  opportunity. 

Among  some  of  the  African  tribes  and  those  people 
inhabiting  the  Eastern  Archipelago,  crime  is  the  rule — in 
fact,  in  some  parts  of  Borneo  a  3^oung  man  cannot  marry 
unless  he  has  killed  at  least  one  man.  The  ancient  Greeks 
sought  to  calm  the  winds  by  human  sacrifices,  and  mythol- 
ogy tells  us  that  crime  was  triumphant  in  heaven.       By  the 

119 


120.  ETIOLOGY  OF   OSSEOUS   DEFORMITIES  OF 

laws  of  the  middle  ages,  theft  by  a  common  man  was  consid- 
ered much  worse  than  if  committed  by  a  chief;  but  through 
the  increase  of  invasions  and  despotism,  thefts  by  chiefs 
became  a  greater  crime  than  assassination.  The  chiefs,  how- 
ever, v\rho  were  both  judges  and  executive  magistrates,  sought 
to  maintain  laws  which  would  be  advantageous  to  themselves, 
and  it  may  be  that  through  this  selfishness  morality  pene- 
trated society. 

The  germs  of  crime  are  met  with  in  infancy.  It  is  no 
uncommon  thing  for  a  child  to  strike  at  its  parents  or  nurse 
at  the  age  of  one  year,  and  frequently  in  a  fit  of  anger  to  snatch 
at  or  break  small  articles  near  it.  This  is  crime  in  an  embry- 
onic state.  Mendacity  in  children  usually  arises  from  the 
ways  in  which  their  parents  deceive  them  to  render  them 
quiet. 

Cruelty  among  children  is  found  in  all  classes  and  nations, 
and  especially  among  bo3^s;  they  take  delight  in  breaking 
articles,  or  killing  small  animals,  insects  and  worms;  indeed, 
there  seems  to  be  an  element  of  destructiveness  in  their 
nature,  which  is  only  overcome  by  a  strict  moral  training. 

McDonald  says:  "Murder,  no  less  than  anger,  vengeance 
and  cruelty,  is  found  in  children.  Caligula,  at  13,  had  a 
slave  cast  into  an  oven  for  a  slight  oflfense.  Two  children, 
the  one  13.  and  the  other  10  years  of  age,  having  a  spite 
against  a  comrade  of  7  years,  met  him  in  an  out-of-the-way 
place,  threw  him  into  a  deep  hole,  and  stoned  him  to  death. 
A  boy  in  the  state  of  Iowa  (11  years  of  age)  went  early  in 
the  morning  into  the  room  where  his  grandparents  were 
sleeping,  and  shot  them  both;  seeing  his  grandfather  move, 
he  finished  him  with  an  ax.  He  told  the  boys  afterward:  'I 
did  it  all  alone.'  The  occasion  of  his  deed  seems  to  have 
been  a  refusal  to  allow  him  to  do  something.  Another  boy 
of  13  stabbed  his  comrade  in  the  heart  because  he  refused  to 
'pay  a  debt  he  owed  him  for  a  game.  Such  crimes  in  the  case 
of  children,  if  less  cruel  than  in  the  case  of  adults,  are  so 
from  the  lack  of  force  rather  than  ferocity,"  This  is  also 
nicely  illustrated  in  the  familiar  circumstance  of  the  epileptic 
Pomeroy,  of   Boston,  who  was  in  the  habit  of   spending  his 


THE    HEAD,    FACE,    JAWS   AND   TEETH  121 

leisure  moments  amusing  himself  by  sticking  his  knife  into 
his  playmates,  and  finally  enticed  one  of  his  comrades  into  a 
belfry  and  killed  him  in  the  same  manner. 

From  a  sociological  standpoint,  war  is  but  universal  mur- 
der, and  in  primitive  times  its  terrible  character  even  sur- 
passed the  ferocity  of  wild  beasts.  In  these  early  times  the 
enemy  was  mutilated  and  tortured,  but  modern  war  has  done 
away  with  torture,  and  at  the  present  time  inventive  genius 
is  striving  its  utmost  to  discover  how  to  kill  and  disable  the 
enem}^  at  great  distances,  and  in  this  achievement  they  have 
almost,  if  not  quite,  succeeded,  much  to  the  disgrace  of  the 
enlightened  nineteenth  century.  We  look  upon  the  cannibal 
with  horror,  yet  the  words  of  Montaigne  come  most  vividly 
back  to  us;  ''  It  is  more  barbarous  to  kill  a  live  man  than  to 
roast  and  eat  a  dead  one." 

A  minute  and  careful  analysis  has  been  made  of  the  his- 
tory of  each  individual  hereafter  cited,  to  show  the  different 
crimes  under  which  each  person  was  sentenced,  and  also  to 
show  that  no  two  are  exactly  alike.  It  has  also  been  shown 
that  the  deformities  of  the  osseous  system  (excess  and  arrest 
of  development)  are  unusually  common  and  differ  in  each 
individual.  This  collection  of  skulls  of  criminals  and  degen- 
erates is  certainly  the  most  interesting  that  can  be  found  in 
this  country,  and  the  author  was  very  fortunate  to  be  able  to 
secure  them  for  the  purpose  of  obtaining  these  illustrations. 
It  would  not  be  possible  to  obtain  skulls  of  as  many  degener- 
ates of  any  other  class,  but  the  author  is  free  to  assert  that 
as  marked  deformities  can  be  found  among  the  other  classes 
of  degenerates.* 

"Lombroso,  Ferri  and  Manouvrier  claim  certain  peculiari- 
ties of  development  in  the  criminal  jaw.  Exaggerated  devel- 
opment of  the  zygomas  and  lower  jaw  is  the  especial  feature 
commented  upon  by  Lombroso.  Ferri  has  found  the  greatest 
diameter  of  the  jaws  among  homicides  and  petty  criminals; 
the  smallest  among  professional  murderers  and  pickpockets. 

*  The  following  on  the  subject  of  Crime,  is  from  a  joint  paper  on  "  Studies 
of  Criminals,"  by  G.  Frank  Lydston  and  the  author,  taken  fvoui  the  Alienist 
and  Neurologist,  St.  Louis,  October,  1881. 


122  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

The  jaws,  according  to  Ferri,  are  not  well  developed  among 
the  insane,  save  those  who  are  the  subjects  of  impulsive 
monomania.  This  does  not  agree  with  Dr.  Talbot's  observa- 
tions. 

In  our  studies  of  criminals  we  have  found  that  the  most 
marked  variations  from  the  average  normal  type  of  cranial 
development  occur  among  the  habituals.  We  have  made  no 
attempt  to  select  special  cases  bearing  out  this  assertion,  but 
have  studied  each  case  as  it  has  been  taken  at  random.  We 
append  a  series  of  observations  upon  criminals,  selected  by  a 
convict  orderly  from  among  the  habituals  and  murderers  in 
the  Joliet  penitentiary.  In  reply  to  his  inquiry  as  to  what 
kind  of  cases  we  wished  to  study,  we  remarked  that  we 
wished  to  see  old-timers  or  habituals.  He  therefore  selected 
the  prisoners  according  to  their  criminal,  with  an  entire  dis- 
regard to  their  physical  status,  with  the  possible  exception 
of  several  who  happened  to  be  on  sick  call.  All  complaints 
of  subjective  ailments  were  verified  by  the  resident  medical 
officers. 

I  present  the  history  and  description  of  several  of  these, 
selected  from  the  original  paper. 

Obs.  I. — White,  male,  American,  aged  thirty  years.  Has 
been  committed  twice  for  burglary.  Was  first  committed  at 
the  age  of  twenty-two,  since  which  time  has  been  a  con- 
firmed criminal.  Hereditary  influences  as  a  possible  cause  of 
delinquency  not  probable.  Intemperance  is  admitted,  and  is 
claimed  to  have  had  much  to  do  with  his  moral  degradation, 
and  as  he  is  markedly  neurotic  this  is  highly  probable. 
Syphilis  is  denied.  Never  experienced  an  injury  until  two 
years  ago,  when  he  received  a  severe  fall,  with  contusion  of 
of  the  head.  This  was  followed  by  epilepsy,  severe  head- 
aches, insomnia,  deafness,  defective  vision  in  the  right  eye 
and  pronounced  right  hemiplegia.  Hearing  normal.  Mentality 
impaired.  He  is  thin,  anaemic  and  badly  nourished.  Was 
formerly  right-handed,  but  has  acquired  left-handedness  since 
the  accident.  The  jaws,  especially  the  inferior,  arc  quite  asym- 
metrical and  the  nose  deflected,  not  from  traumatism.  Features 
very  asymmetrical.      Ears  small,  protuberant,  pointed  and 


THE     HEAD,    FACE,    JAWS   AND    TEETH  123 

asymmetrical,  the  left  being  the  larger  and  more  prominent. 
The  septum  nasi  is  thickened  and  greatly  deflected.  Cranium 
of  medium  development,  of  sub-brachy cephalic  type  and  rafter 
shaped  calvarium.  Jaw,  orthognathous.  Occipital  region 
very  prominent  and  asymmetrical,  the  protuberance  being 
markedly  deviated  to  the  left  of  the  median  line.  Pro- 
nounced asymmetry  of  parietal  development,  the  left  emi- 
nence being  very  prominent  and  the  right  perceptibly  flat- 
tened.    Palate  imperfectly  developed  with  a  V-shaped  arch. 

Obs.  II. — White,  male,  Irish,  aged  twenty-seven  years. 
Sentenced  for  arson.  Committed  for  the  second  time,  the 
first  offense  being  robbery.  Has  led  a  criminal  life  since 
childhood,  being  addicted  to  petty  and  minor  delinquencies 
for  which  he  escaped  punishment.  Knows  nothing  of  his 
parentage  or  family.  Has  never  been  addicted  to  drink. 
Admits  syphilis.  Is  thin,  ansemic  and  poorly  nourished; 
says  that  he  was  never  very  strong.  Right-handed.  No 
lameness  or  deformity.  Slightly  deaf.  Vision  normal.  Per- 
ceptive faculties  somewhat  blu»ted  and  mental  processes 
sluggish.  Is  a  melancholiac,  and  suffers  from  severe  head- 
aches. Features  noticeably  asymmetrical.  Nose  percepti- 
bly deflected  and  flattened,  not  traumatically.  Septum  thick, 
crumpled  and  on  the  right  side  enchondromatous,  the  right 
nostril  being  occluded.  The  ears  are  peculiarly  deformed, 
the  right  being  small,  thick  and  crumpled,  the  left  of  medium 
size  and  very  protuberant,  handle-shaped.  Cranium  large, 
ultra-brachy cephalic,  with  platycephalic  vertical  index,  and 
resembling  in  its  general  outline  the  skull  shown  in  Fig.  33. 
To  the  left  of  the  vertex  the  calvarium  is  flattened,  but  the 
left  parietal  protuberance  is  very  prominent,  the  entire  left 
side  bulging  in  outline.  The  right  side  is  flattened  and  the 
parietal  prominence  slightly  marked.  The  body  of  the 
occipital  bone  is  very  straight  and  flat,  but  the  protuberance 
is  disproportionately  prominent.  The  facial  outline  is  orthog- 
nathous, the  jaw  being  of  a  pronounced  retreating  type  and 
very  asymmetrical.     Palatal  arch  V-shaped. 

Obs. III. — White,  male,  American,  aged  forty  years.  Serv- 
ing second  sentence  for  burglary.     Prior  to  first  commitment 


124  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

had  been  sentenced  for  numerous  petty  delinquencies,  and 
had  been  tried  on  charges  of  burglary  and  acquitted  on  sev- 
eral occasions.  History  shows  a  bad  heredity.  Mother 
healthy,  but  father  died  of  consumption,  and  a  sister  is  sub- 
ject to  fits.  Has  been  addicted  to  liquor.  Says  that  liquor 
is  responsible  for  his  life  of  criminality  (?).  Contracted 
syphilis  eighteen  years  ago.  which  has  troubled  him  off  and 
on  ever  since.  General  appearance  very  fair,  is  well  nour- 
ished and  of  good  color.  Eight-handed.  No  lameness  or 
deformity,  but  plentifully  supplied  with  syphilitic  scars.  Is 
quite  deaf,  and  vision  is  so  defective  that  he  reads  with  diffi- 
culty. Suffers  from  tinnitus  aurium.  The  facial  contour  of 
this  man  is  ver}^  striking.  There  is  such  a  marked  disparity 
and  asymmetry  of  the  two  sides  of  the  face  that  it  has  the 
appearance  of  two  halves  of  faces  of  different  sizes  joined 
together  and  by  a  bad  artisan.  Nose  deflected  markedly  and 
septum  twisted  and  malformed  so  that  the  left  nostril  is  com- 
pletely blocked.  The  ears  are  very  asymmetrical  and  situ- 
ated on  different  planes,  the  right  ear  being  much  the 
smaller  and  situated  several  lines  higher  than  the  left. 
Cranium  sub-microcephalic  and  very  asymmetrical.  The 
right  side  of  the  cranium  is  very  perceptibly  flattened  and  the 
parietal  prominence  feebly  marked.  The  left  prominence  is 
very  marked.  The  forehead  is  low  and  retreating.  The 
narrow  and  contracted  skull  in  this  case  is  directly  noticea- 
ble, but  the  index  is  sub-brachycephalic  on  account  of  the 
markedly  sloping  frontal  region,  which  compensates  in  a 
measure  for  the  narrow  transverse  diameter.  The  facial 
type  is  orthognathous.  On  examining  the  mouth,  a  high 
palatal  vault  of  partial  V-shape,  with  pronounced  saddle 
contour  on  the  right  and  full  curve  on  the  left,  are  noted. 
There  is  marked  faucial  and  pharyngeal  asymmetry. 
There  is  a  lateral  curvature,  which  accounts,  in  a  measure, 
for  the  pharyngeal  and  faucial  deformity.  An  interesting 
feature  of  this  case  is  that  the  subject  suffered  from 
constant  and  severe  headaches  until  fifteen  years  of 
age.  The}'  then  stopped,  Imt  were  developed  later  in  life 
by  liquor.    Has  had  them  steadily  for  the  last  fifteen  months, 


THE     HEAD,    FACE,    JAWS   AND   TEETH  125 

and  is    siifferino:  from   insomnia — possible    pachymeningitis 
syphilitica  or  alcoholica  suggests  itself  in  this  connection. 

Obs.  IV. — White,  male,  German  extraction,  age  forty-one 
years.  Serving  time  for  murder.  This  case  is  most  interest- 
ing as  an  example  of  illogical  dispensation  of  law  and  of  the 
physical  basis  of  crime.  The  subject  is  typically  neurotic; 
heredity  bad,  mother  having  died  of  cancer  and  her  branch  of 
the  family  being  subject  to  various  forms  of  nervous  disease. 
Cause  of  father's  death  unknown,  but  he  was  known  to  have 
been  a  dissolute  character.  The  subject  under  consideration 
was  struck  in  the  head  with  a  hatchet  when  a  child.  Since 
the  age  of  eight  he  has  had  epilepsy,  the  fits  occurring 
sometimes  every  three  or  four  days  and  at  others  at  very  long 
intervals.  Has  at  times  escaped  them  almost  entirely  for  a 
■year  or  two,  and  has  then  brought  them  on  by  indulgence  in 
liquor,  to  which  he  was  addicted;  subject  to  violent  paroxysms 
of  fury  at  all  times  under  slight  provocation;  has  been  com- 
mitted to  the  asylum  several  times;  history  would  seem  to 
point  to  the  furor  epiiepticus  as  a  cause  for  the  murder  which 
this  man  committed.  The  noteworthy  fact  is  that  this  man 
is  very  artistic  and  spends  much  of  his  time  in  making  artificial 
flowers.  Syphilis  is  denied,  and  no  evidences  of  the  disease  are 
perceptible;  subject  is  pale  and  ansemic;  is  right-handed;  vision 
normal,  but  is  quite  deaf  in  left  ear;  no  deformity  or  lame- 
ness. Features  very  asymmetrical,  the  right  side  of  the  face 
being  much  larger  than  the  left.  The  nose  is  markedly 
deflected  to  the  left,  the  septum  being  thickened,  crumpled 
and  deviated  in  the  same  direction.  Ears  very  asymmetrical, 
the  left  being  the  larger,  higher  situated  and  badlj^  formed. 
The  right  ear  is  very  protuberant,  imperfectly  developed 
and  crumpled.  Cranium  of  medium  size,  quite  round  and 
dome-shaped.  Vertical  index  oxycephalic.  Index  markedly 
brachy cephalic.  The  skull  shows  the  same  asymmetry  as  the 
face,  the  right  side  being  disproportionally  developed  and  the 
right  parietal  eminence  very  large.  The  left  side  is  flattened 
and  the  parietal  prominence  barely  distinguishable.  The  arch 
of  the  jaw  in  this  case  is  normal,  but  the  development  of  the 
palate  is  defective  and  the  rami  defective  in  development. 


126        ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

Ohs.  V. — White,  male,  American,  aged  thirty-seven  years. 
Committed  for  the  third  time  for  burglary.  Family  history 
unknown  save  as  regards  mother,  who  died  of  cancer.  Has 
had  syphilis,  and  has  been  intemperate  since  youth.  Was 
hurt  in  a  railroad  accident  in  1881.  Prior  to  this  time  he 
had  worked  tolerably  steadily,  but  since  the  accident  he  had 
drank  harder  than  ever  and  had  developed  an  uneasy,  rest- 
less disposition,  which  made  honest  labor  Irksome  and  crim- 
inality attractive.  General  appearance  fair,  is  well  nour- 
ished. Right-handed  and  has  no  lameness  or  deformity.  Com- 
plains of  tinnitus  in  the  right  ear,  referable  he  thinks  to  the 
railroad  accident.  Vision  and  hearing  normal.  Face  very 
asymmetrical,  the  right  side  being  much  the  larger.  Right 
malar  prominence  exceptionally  marked.  Left  eye  so  dis- 
proportionally  small  as  to  attract  the  attention  of  the  casual 
observer.  Nose  deformed  and  septum  deviated  to  the  left, 
but  as  the  organ  has  been  broken  this  point 'is  not  of  great 
importance.  Ears  very  small,  crumpled  and  closely  set, 
the  left  being  much  the  larger  and  lower.  The  skull 
is  submicrocephalic  in  capacity,  oxycephalic  in  its  ver- 
tical and  brachycephalic  in  its  cranial  index.  The  right 
half  of  the  cranium  is  the  smaller,  with  the  exception  of 
right  occipital  and  mastoid  regions,  which  are  excessively 
developed.  The  left  parietal  eminence  is  very  prominent. 
None  of  the  aberrations  noted  were  referable  to  the  injury, 
except  possibly  the  nasal  deformity.  The  superior  maxilla 
is  V-shaped. 

Obs.  VI. — White,  male,  Irish,  aged  fifty  years.  Serving  a 
five-year  sentence  for  horse  stealing.  Served  a  six-year 
sentence  twenty  years  ago  for  the  same  offense.  Acknowl- 
edges repeated  offenses  for  which  he  has  never  been  punished. 
Family  history  not  clear,  but  says  that  father  died  of  old 
age  and  mother  of  "fever  sore  "  on  her  leg;  has  been  intem- 
perate since  youth,  and  has  had  severe  syphilis;  has  had 
severe  small-pox,  with  resulting  great  disfigurement,  not 
shown  in  cut;  general  appearance  fairly  healthy;  is  very 
awkwardly  built,  "slab-sided"  as  the  orderly  expressed  it; 
his  gait  is  of  the  shuffling  or  shambling  variety;    is  right- 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


127 


handed;  is  lame  as  a  consequence  of  syphilis;  hearing  nor- 
mal; vision  has  been  impaired  for  many  years;  features 
very  asymmetrical;  the  face  is  long  and  narrow  and 
the  chin  pointed,  but  not  prognathous;  the  left  eye  much 
smaller  than  the  right,  not  properly  shown  in  cut,  and  the 
entire  left  side  of  the  face  imperfectly  developed;  the  nose  is 
slightly  flattened  and  the  septum  deviated  to  the  left,  the 
nostril  being  nearly  occluded;  the  ears  are  asymmetrically 
developed,  the  left  being  the  larger,  most  thickened,  irregu- 
lar and  deformed;  cranial  index  brachy cephalic;  vertical 
index    platycephalic;    the   large    size   and   disproportionate 


Pig.  28. 

breadth  of  the  cranium  are  very  noticeable.  The  cranium  is 
asymmetrically  developed.  The  right  frontal  eminence  is 
very  prominent.  The  left  parietal  prominence  is  very  large. 
The  calvarium  is  depressed  at  the  right  of  the  vertex.  There 
is  also  a  well-defined  depression  at  the  bregma.  The  right 
occipito-mastoid  region  is  excessively  developed  (Fig.  28;. 
The  generally  twisted  appearance  of  cranium  already  alluded 
to  is  well  shown  in  this  subject.  The  jaws  are  saddle- 
shaped,  and  the  palate  irregular  and  unevenly  developed. 
The  actions  and  garrulous  conversation  of  this  subject 
showed  him  to  be  a  paranoiac  of   a  pronounced  type.     A 


V2S 


ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 


glance  at  the  physiognomy  of  this  man,  as  shown  in  Fig.  29, 
is  suggestive  to  the  neiii'oU)gist  in  this  connection.  A 
marked  sunken  condition  is  noticed  under  the  eyes,  extend- 
ing down  to  the  lower  jaw,  showing  arrest  of  development  of 
the  bones  of  the  face. 

Obs.  VII. — White,  male,  American,  aged  fifty-three  years. 
Sentenced  for  horse  stealing.  Had  several  sentences  elsewhere, 
and  is  serving  a  second  term  in  Joliet.  Family  history  not 
obtainable;  had  been  occupied  in  farming  and  horse  dealing, 
alternating  with  horse  stealing  most  of  his  life;  no  history  of 
syphilis  or  alcoholism;  general  appearance  bad,  pallor  and 


Fig.  29. 

cachexia  being  pronounced;  is  right-handed;  presents  no 
lameness  or  deformity;  vision  and  hearing  normal;  the  feat- 
ures are  very  asymmetrical;  the  nose  is  quite  straight,  but 
the  septum  is  deviated  to  the  left,  producing  partial  occlu- 
sion; the  eyes  are  small,  deep-set  and  somewhat  of  the 
slanting  type  peculiar  to  the  Mongolian.  This  peculiar  slant 
is  most  evident  upon  the  right  side;  the  right  eye  is  also 
smaller  and  on  a  higher  plane  than  the  left.  The  difference 
in  development  of  the  two  sides  of  the  face  is  very  marked, 
the  right  being;  the  smaller.  The  left  half  of  the  inferior 
maxilla  is  much  lono;er  and  straijjhter  than  the  rio^ht.      Hair 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


129 


has  been  very  gray  since  quite  a  young  man.  The  right  ear 
is  of  moderate  size,  of  fair  form  and  very  closely  set;  the 
left  is  flattened,  flabby  and  protuberant,  "handle-shaped" 
and  lower  than  the  right.  Cranial  capacity  is  mesocephalic 
and  cranial  index  sub-brachycephalic.  The  vertex  is  pointed, 
oxycephalic,  with  marked  depression  upon  each  side  of  the 
median  line.  The  left  occipito-mastoid  region  is  exceedingly 
prominent,  the  right  being  deficiently  developed.  The  left 
parietal  eminence  is  very  prominent  and  the  right  poorly 
marked.  Semi- V-shaped  superior  maxilla;  lower  maxilla  well 
developed.    This  subject  is  an  apt  illustration  of  the  irony  of 


Tig.  30. 

fate  and  the  unintelligent  administration  of  law.  He  is  a 
paranoiac  and  affected  with  monomania  of  the  religious  delu- 
sional type.  At  times  imagines  himself  Jesus  Christ.  He 
preaches  in  his  cell  to  imaginary  spirits,  over  which  he  imagines 
that  he  has  control,  and  regales  his  fellow-convicts  with  an 
occasional  sermon  on  their  wicked  ways.  His  conversation  is 
characterized  by  egotistical  garrulity;  is  particularly  desirous 
of  impressing  us  with  the  idea  that  his  magnificent  head  was 
designed  for  some  great  purpose  which  "died  a-bornin'." 
Like  the  preceding  case,  the  physiognomy  of  this  subject 
(Fig.   30)  is   to  the  alienist  confirmatory  of  the  foregoing 


130  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

remarks.  Here  is  also  noticed  arrest  of  development  of  the 
face  at  the  alae  of  the  nose — showing  the  prominent  check 
bone  and  lower  jaw  of  Lombroso.  Right  eye  much  higher 
than  left. 

Obs.  VII  L. — AYhite,  male,  Swede,  aged  thirty  years.  Up 
for  larceny,  second  conviction,  and  acknowledges  offenses  for 
which  he  was  never  punished;  has  worked  at  different  trades 
and  occupations,  but  labored  steadily  until  he  received  the 
injury  herewith  described.  Family  history  obscure;  mother 
had  some  skin  disease  of  a  severe  type;  has  been  a  moderate 
drinker;  syphilis  is  denied;  general  condition  fair;  is  some- 
what anaemic;  is  right-handed;  some  years  ago  was  caught  in 
a  railroad  smash-up  and  sustained  a  fracture  of  the  skull; 
several  years  ago  had  his  arm  caught  in  machinery  and 
received  a  compound  fracture  of  the  forearm;  was  in  hospi- 
tal seven  months.  Hearing  greatly  impaired;  vision  normal. 
The  face  is  very  asymmetrical,  the  right  side  being  the  bet- 
ter developed,  and  the  right  half  of  the  jaw  especially  promi- 
nent; nose  of  normal  type;  no  deflection  of  septum;  ears  very 
asymmetrical,  the  left  being  the  larger  and  more  closely  set 
and  decidedly  pointed;  the  right  is  of  medium  size  and  nor- 
mal outline,  but  situated  lower  than  the  left;  jaws  square 
and  well  formed,  but  the  hard  palate  is  very  asymmetrical; 
left  palatal  process  much  broader  than  the  right.  The 
cranium  is  large,  horizontal  index  brachycephalic;  vertical 
index  platycephalic;  the  frontal  region  is  asymmetrical,  the 
right  prominence  bulging  decidedly;  the  parietal  prominences 
are  exceptionally  well  marked,  the  left  being  much  the 
larger;  the  entire  right  half  of  the  cranium  is  disproportion- 
ately well  developed,  with  the  exception  of  the  parietal  emi- 
nence; depression  at  site  of  old  injury  in  parietal  region. 
This  subject,  like  the  foregoing,  should  not  be  in  prison.  He 
is  a  paranoiac — has  delusions  of  persecution,  quarrels  with 
imaginary  enemies  in  his  cell,  and  has  on  one  occasion 
attempted  suicide  by  cutting  his  throat. 

Obs.  IX. — White,  male,  American,  aged  fifty-nine  years. 
Fourth  commitment;  ofiense,  horse  stealing;  committed  three 
times  before  on   "general  principles;"  does  not  deny  that 


THE    HEAD,    FACE,    JAWS   AND   TEETH  131 

said  commitments  were  for  the  public  good;  heredity  bad; 
father  died  of  cancer  of  the  stomach,  mother  was  insane  and 
died  of  comsumption;  says  he  does  not  give  a  "fake"  his- 
tory for  the  purpose  of  exciting  sympathy — sa3'^s  his  motto 
is:  "Sympathy  be  d— d!"  He  has  never  been  intemperate; 
says  that  he  feared  to  drink  on  account  of  the  insanity  in  his 
blood;  syphilis  is  denied;  had  his  head  cut  by  a  rock  in 
Cliester  penitentiary  years  ago.  General  appearance  quite 
bad;  is  anaemic  and  poorly  nourished;  was  originally  right- 
handed,  but  on  account  of  lameness  in  joints  of  right 
hand  has  acquired  the  use  of  left;  left  arm  is  also  lame 
from  injury;  joints  are  generally  crippled  by  arthritis 
deformans;  vision  presbyopic;  hearing  normal.  The  face  is 
very  asymmetrical,  the  right  side  being  the  larger;  nose 
malformed  and  deflected  to  the  right;  septum  deflected  and 
presents  a  large  perforation;  ears  of  average  development 
and  symmetry;  right  ear  a  little  lower  than  left;  dental 
arches  normal  but  inferior  maxilla  greatly  flattened  at 
angles  and  quite  asymmetrical;  cranium  of  average  develop- 
ment; sub-brachycephalic  index.  Since  the  injury  to  his 
head  this  man  states  that  he  has  "wild  spells"  when  his 
mind  is  aberrated.  These  "spells"  follow  severe  headaches. 
This  man,  although  uneducated,  is  quite  talented,  very  bright 
and  logically  argumentative.  His  moral  obliquity  is  evi- 
dently due  to  a  bad  heredity  and  lack  of  mental  discipline. 
Under  more  favorable  auspices  he  would  have  made  a  valua- 
ble member  of  society.     Arrest  of  bones  of  the  face. 

Obs.  X.^ — ^ White,  male,  German,  age  thirty-one  years. 
Serving  sentence  for  grand  larceny.  Has  been  in  prison  Ave 
times,  this  being  his  third  term  in  Joliet.  Heredity  bad;  father 
healthy  but  intemperate,  quarrelsome  and  subject  to  violent 
fits  of  passion,  which  made  him  a  "dangerous  customer"  at 
times;  an  only  brother,  though  honest,  is  intemperate  and 
a  ne'er-do-well;  paternal  grandfather  said  to  have  been  a 
martyr  to  scrofula.  Has  not  been  intemperate ;  syphilis  denied, 
but  states  that  he  was  very  scrofulous  as  a  child;  extensive 
scrofulitic  scars  visible  on  neck  and  face;  is  still  quite  sickly, 
looks   cachectic  and  badly   nourished;  is  right-handed;  no 


132  ETIOLOGY  OF   OSSEOUS   DEFORMITIES  OF 

lameness  or  deformity,  vision  and  hearing  normal;  facial 
asymmetry  quite  marked,  the  right  side  being  much  the 
larger.  The  nose  is  markedly  deviated  to  the  left  and  the 
septum  much  deformed  and  deviated  to  the  right,  producing 
almost  complete  occlusion.  The  left  palpebral  fissure  much 
smaller  than  right;  left  eye  perceptibly  smaller  than  right; 
ears  fairly  symmetrical  and  well  formed;  cranium  very  large, 
index  ultra-brachycephalic,  vertical  index  platycephalic;  fair 
degree  of  symmetry;  left  parietal  eminence  very  promi- 
nent. This  subject  has  been  affected  with  severe  stammering 
since  childhood;  is  frequently  under  treatment  for  severe 
cephalalgia,  and  has  had  since  childhood  what  he  terms 
"dumb  spells,"  which  we  interpret  as  mental  depression, 
probably  associated  with  disturbed  circulation.  The  inferior 
maxilla  in  this  case  was  poorly  developed,  orthognathous  and 
very  pointed;  upper  jaw  presents  a  marked  saddle-shaped 
arch.     Arrest  of  bones  of  the  face. 

Obs.  XI. — White,  male,  Swede,  aged  twenty-seven  years. 
Acknowledges  habitual  criminality,  though  serving  first  sen- 
tence; is  in  for  highway  robbery;  heredity  not  shown;  mother 
died  of  dropsy  and  father  of  pneumonia;  intemperance  and 
syphilis  both  admitted;  no  history  of  injury;  general  appear- 
ance fair;  right-handed;  somewhat  lame  in  left  leg  (thinks 
that  he  always  was  weak  in  this  limb);  vision  and  hearing  nor- 
mal; face  asymmetrical,  leftside  much  the  larger — leftside 
of  the  lower  jaw  being  extraordinarily  prominent;  left  pal- 
pebral fissure  and  eyeball  much  smaller  than  the  right;  nose 
deflected  to  the  right,  Avith  marked  corresponding  deviation 
of  septum;  ears  very  large,  long,  pointed  and  closely  set; 
cranium  sub-microcephalic,  with  sub-brachy cephalic  index; 
oxycephalic  vertical  index.  Development  of  average  sym- 
metry. In  his  general  characteristics  this  subject  is  a  weak- 
ling, and  the  crime  for  which  he  is  doing  time  is  inconsistent 
with  his  physique.  The  jaws  in  this  case  are  markedly 
deformed,  the  upper  presenting  a  semi-V  and  the  lower  a 
marked  saddle,  with  arrest  of  bones  of  the  face. 

Obs.  XII. — White,  male,  half-breed  Egyptian,  age  thirty- 
five  years.   Serving  sentence  for  horse  stealing.   Says  that  it  is 


THE    HEAD,    FACE,    JAWS    AND   TEETH  133 

his  first  commitment,  but  his  statements  are  contradictory,  and 
he  has  either  been  committed  before  or  has  led  a  criminal  life 
without  punishment;  the  family  history  is  imperfect,  as  he 
was  born  in  Egypt  of  a  native  mother  and  an  American  father. 
One  brother  is  known  to  be  insane  but  not  criminal;  has 
drank  periodically  after  he  has  had  one  of  the  "fits,"  to  be 
described;  syphilis  denied;  when  quite  a  young  man  he 
enlisted  in  the  American  navy  and  served  for  some  years; 
was  finally  discharged  for  disability,  having  been  sunstruck 
while  in  the  foretop,  falling  to  the  deck  and  sustaining  severe 
head  injuries,  the  scars  of  which  still  remain.  After  his  dis- 
charge he  suffered  from  epileptic  fits  at  intervals  of  from  a 
few  days  to  a  few  weeks;  is  still  suffering  from  these  attacks 
and  from  severe  headaches;  criminal  career  began  since 
injury  (?).  General  appearance  excellent;  right-handed;  no 
lameness  or  deformity;  head  badly  scarred  from  old  wounds; 
vision  and  hearing  normal;  face  fairly  symmetrical;  eyes 
equally  developed;  right  side  of  face  slightly  the  larger; 
nose  not  deformed,  but  septum  deviated  to  the  right,  with 
partial  occlusion  of  nostril;  ears  very  small,  closely  set  and 
crumpled.  Cranium  large  and  index  sub-brachycephalic; 
development  asymmetrical;  right  side  much  the  larger; 
occiput  unequally  developed,  righthalf  being  very  prominent; 
left  parietal  eminence  very  large  as  compared  with  the  right; 
jaws  normal.  Degeneracy  of  physical  type  is  not  very  pro- 
nounced in  this  subject.  We  consider  the  history  of  injury 
a  very  important  point. 

Obs.  XIII. —  White,  male,  American,  aged  twenty-six 
years.  Committed  for  the  first  time  for  forgery ;  acknowledges 
petty  delinquencies  before  sentence  for  forgery;  family  his- 
tory bad;  father  delicate,  scrofulous  and  affected  all  his  life 
with  sore  eyes;  mother  died  of  consumption;  has  been  a 
steady  but  moderate  drinker  ;  syphilis  denied ;  general 
appearance  good;  right-handed;  vision  and  hearing  normal; 
face  quite  asymmetrical,  left  half  much  the  larger;  left  eye 
much  smaller  than  right;  nose  straight  and  symmetrical,  but 
septum  markedly  deformed;  ears  symmetrical,  but  very 
small  and  closely  set;  cranium  of  medium  size  and  asymmet- 


13-f  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

rical;  index  mesogephalic;  left  occipito-parietal  region  dis- 
proportionately developed;  right  half  of  occiput  flattened; 
protuberance  situated  seven  mm.  to  the  left  of  the  median 
line;  left  parietal  eminence  very  prominent;  facial  develop- 
ment marked;  pronounced  prognathism  of  inferior  maxilla. 

Obs.  XIV. — White,  male,  Irish  (typical  imported  crimi- 
nal), aged  fifty-four  years.  In  for  bank  robbery  on  long  sen- 
tence. This  is  one  of  the  toughest  specimens  that  ever  broke 
into  jail;  he  has  done  time  in  a  number  of  prisons  in  Amer- 
ica, and  served  several  sentences  in  England  before  being 
exported  to  this  country  by  the  generous  British  authorities; 
family  history  bad;  father  intemperate;  both  parents  died  of 
consumption  while  subject  was  very  young;  one  brother  died 
of  consumption;  has  always  been  a  hard  drinker;  has  had 
syphilis;  general  appearance  very  bad;  is  thin,  sallow  and 
badly  nourished;  has  a  chronic  cough;  is  somewhat  crippled 
by  rheumatism,  otherwise  no  lameness  or  deformity;  hearing 
normal;  vision  impaired  by  age;  face  very  asymmetrical, 
left  side  being  disproportionately  developed;  left  eye  per- 
ceptibly the  larger;  right  frontal  prominence,  however,  is 
bulging  and  prominent;  nose  badly  deformed;  septum  enchon- 
dromatous  and  deflected,  and  so  badly  deformed  that  it  is 
visible  externally;  ears  very  prominent  and  pointed;  the  left 
is  badly  crumpled;  cranium  sub-microcephalic;  index  sub- 
dolichocephalic;  fairly  uniform  development  on  each  side, 
but  right  side  much  the  larger;  lower  jaw  small,  prognathous 
and  left  half  much  the  larger;  upper  jaw  large,  with  low 
arch. 

Obs.  XV. — White,  male,  Dane,  aged  forty-two  years. 
Serving  life  sentence  for  murder;  family  history  good;  has 
never  been  intemperate,  and,  until  the  commission  of  the 
crime  for  which  he  is  under  sentence,  he  was  an  honest,  hard- 
working farmer,  distinguished  only  by  a  violent  temper;  the 
murder  for  which  he  is  doing  time  was  the  result  of  a  quar- 
rel; has  never  had  syphilis;  general  appearance  excellent; 
rioht-handed;  vision  and  hearing  normal;  no  lameness  or 
deformity,  features  asymmetrical,  the  preponderance  of 
development   being   on   the   left   side;   nose   deformed   and 


THE     HEAD,    FACE,    JAWS    AND   TEETH  135 

deflected  to  the  right;  septum  shows  a  corresponding  deflec- 
tion; ears  asymmetrical,  the  right  being  pointed,  closely  set 
and  of  medium  size,  the  left  large,  protuberant  and  lower 
set  than  the  right;  cranial  capacity  mesocephalic;  index 
sub-brachy cephalic;  pronounced  asymmetry,  the  left  side 
being  the  larger,  the  development  of  the  left  occipito-parietal 
region  being  especially  disproportionate;  the  right  parietal 
eminence  is  much  larger  than  the  left;  the  forehead  is  low 
and  retreating;  frontal  prominence  slightly  marked  on  left 
side,  and  absent  on  right;  upper  jaw  excessively  developed 
and  prominent;  arch  semi- V-shaped;  lower  jaw  prognathous 
and  heavy,  and  disproportionately  developed  on  the  left 
side. 

Obs.  XVI. —  White,  male,  American,  aged  forty-two 
years.  Serving  a  life  sentence  for  a  murder  which  had  been 
committed  in  a  quarrel.  Prior  to  this  crime  had  been  an 
industrious  farmer.  Family  history  unknown;  alcoholism 
and  syphilis  denied;  general  appearance  fair;  right-handed; 
no  lameness  or  deformity;  is  lame  at  times  from  rheumatism; 
vision  impaired;  hearing  normal;  nose  well  shaped;  no 
deflection  of  septum;  ears  small,  thin  and  closely  set;  cra- 
nium above  the  average  capacity  and  fairly  symmetrical; 
index  brachy cephalic;  some  flattening  at  the  bregma  and  in 
the  occipital  region;  upper  jaAV  excessively  developed  and 
partial  V-shape;  lower  jaw  massive  and  prognathous. 

Obs.  XVII. — White,  male,  aged  seventeen  years.  This  is 
one  of  the  most  melancholy  cases  which  have  come  under  our 
observation — the  prisoner,  a  bright,  handsome  boy,  having 
been  sentenced  for  life  for  a  murder  committed  while  under 
the  influence  of  liquor.  The  lad  was  raised  on  a  farm  and  his 
family  history  is  unexceptionable.  Habitual  intemperance 
denied;  no  history  of  syphilis;  general  appearance  excellent, 
but  subject  is  plainly  neurotic;  is  right-handed;  no  lameness 
or  deformity;  vision  and  hearing  normal;  facial  development 
quite  symmetrical,  save  a  little  excess  of  development  of  the 
right  half  of  the  inferior  maxilla;  nose  slightly  deviated,  with 
some  deflection  of  septum;  ears  large  and  protuberant  (cm/Z^'s 
a  anse);  capacity  of  cranium   mesocephalic.     Practically  no 


13G  ETIOLOGY   OF   OSSEOUS  DEFORMITIES  OF 

iis\^mmetry.  the  form  of  the  cranium  being  better  than  the 
average  normal  type.  The  lower  jaw  is  asymmetrical,  as 
above  noted,  and  the  upper  jaw  presents  a  partial  V,  with 
arrest  of  the  facial  bones. 

Obs.  XVIII.  White,  male,  American,  aged  sixty-one 
years.  Doing  time  on  fourth  commitment.  Last  offense  burg- 
lary and  arson.  Family  history  unknown.  Was  evidently 
a  vagabond  in  early  life,  but  was  never  convicted  of  crime,  and 
he  states  was  never  delinquent  until  1871,  since  which  time 
he  has  been  in  jail  off  and  on — in  fact,  for  the  greater  part  of 
the  time.  Intemperance  and  syphilis  is  denied.  Drifted  into 
the  army  in  his  early  manhood  and  was  several  times  wounded. 
Is  lame  from  a  saber  cut  in  the  left  leg,  and  head  shows  a 
large  scar  from  a  saber  cut  received  in  '63.  General  appear- 
ance excellent;  vision  and  hearing  normal;  right-handed;  has 
been  gray  for  many  years;  face  fairly  symmetrical;  nose 
slightly  deflected,  but  septum  well  formed;  ears  well  formed; 
cranial  capacity  mesocephalic;  index  brachycephalic;  asym- 
metry not  very  pronounced;  left  parietal  eminence  dispropor- 
tionately prominent;  occipital  region  exceptionally  flat;  mas- 
toid prominences  excessively  developed;  normal  arch  in  upper 
jaw;  lower  jaw  very  prominent,  heavy  and  prognathous. 

The  foregoing  cases  might  be  multiplied  from  the  material 
at  our  command,  but  they  are  amply  sufficient  as  indicative 
of  what  may  be  found  among  the  degenerate  classes  met  with 
in  our  American  prisons.  A  glance  at  these  cases  plainly 
shows  the  physical  degenerac}^  and  often  the  bad  heredity  of 
the  subjects.  A  noteworthy  fact  is  that  the  cases  which  most 
nearly  approximated  the  normal  type  of  development  were 
in  sporadic  criminals,  of  which  the  young  lad  (Obs.  XVII.) 
is  an  example.  It  will  be  noted  that  a  number  of  the  series 
were  of  foreign  birth.  As  before  remarked,  it  will  be  found 
that  the  most  markedly  aberrant  types  are  seen  in  the  imported 
criminal.  This  is  instructive  as  explanatory  of  some  of  the 
apparently  dogmatic  claims  of  European  criminal  anthropol- 
ogists. We  have  found  that  left-handedness  is  not  so  com- 
mon among  American  and  foreign- American  criminals  as  has 
been  claimed  by  these  authorities.     Among  400  criminals  in 


THE    HEAD,    FACE,    JAWS    AND   TEETH  137 

the  Joliet  penitentiary  but  one  per  cent  were  found  to  be 
left-handed.  Dr.  Lydston  found  but  about  two  per  cent 
among  the  criminals  in  the  New  York  City  prison.  Obviously 
a  much  larger  number  of  observations  would  be  necessary  to 
determine  this  point. 

It  is  our  fortune  to  be  able  to  present  in  this  work  a 
series  of  illustrations  of  specimens  showing  the  aberrant 
types  and  asymmetry  found  in  degenerate  skulls,  and 'espe- 
cially those  of  criminals.  These  specimens  are  exception- 
ally interesting  from  the  fact  that  they  have  not  been 
selected  from  among  a  large  number,  but  have  been  picked 
up  here  and  there  by  non-scientists  solely  for  their  morbid  and 


Fig.  31. 

historic  interest,  having  subsequently  fallen  into  Dr.  Lydston's 
hands  quite  by  accident.  It  is  worthy  of  comment  that  even 
the  remarkable  series  depicted  in  Lombroso's  "Atlas"  does 
not  present  such  markedly  aberrant  types  as  this  compara- 
tively small  series  of  studies;  indeed,  a  search  among  several 
thousand  skulls  would  not  be  apt  to  bring  to  light  such  pecu- 
liar types  of  conformation  as  the  crania  which  we  present. 
The  illustrations  are  from  photographs,  and  are  exceptionally 
accurate. 

The  specimen  first  to  be  described  (Fig.  31)  is  one  of  the 
most  interesting  crania  which  we  have  had  the  privilege  of 


138 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


studying.  The  subject  was  a  negro  criminal  of  the  petty 
class,  who  spent  most  of  his  time  in  correctionary  institu- 
tions. As  might  be  inferred  from  the  extremely  degenerate 
type  of  cranial  development,  which  is  here  exhibited,  he  was 
of  a  very  low  grade  of  intelligence.  After  a  very  precarious 
existence  this  negro  committed  suicide. 

In  viewing  this  skull  from  the  front,  one  is  at  once  struck 
by  the  immensely  powerful  maxillary  and  malar  develop- 
ment as  contrasted  with  the  remainder  of  the  cranium.  The 
orbits  are  relatively  very  capacious.  The  superior  maxilla  is 
relatively  poorly  developed,  at  least  as  compared  with  the 
lower  jaw.     Rarely,  indeed,  is  such  an  inferior  frontal  devel- 


Fig.  32. 

opment  found   associated    with    such   a  pronounced  facial 
development. 

As  will  be  seen  in  connection  with  the  specimen  of  brachy- 
cephalic  degeneracy,  shown  in  Figs.  48  and  49,  the  frontal 
development  in  this  narrow  type  of  skull  may  be  vastly  bet- 
ter than  some  specimens  with  a  decided  tendency  to  the 
brachycephalic  type.  The  skull  at  present  under  consider- 
ation is  the  most  marked  specimen  of  the  dolichocephalic 
cranium  which  we  have  seen.  As  the  horizontal  index  in 
this  case  is  59.9,  the  extreme  variation,  according  to  Isaac 
Taylor,  and  others,  being  from  58  to  98,  the  extreme  type  of 
this  skull  is  at  once  obvious. 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


139 


On  viewing  this  skull  laterally  (Fig.  32),  its  strong  sim- 
ilarity to  the  anthropoids  is  very  striking.  This  is  especially 
marked  with  respect  to  the  development  of  the  mastoids  and 
the  occipital  protuberance;  the  position  of  the  latter  is  quite 
an  anomalous  one,  and  the  occipital  bone  is  almost  horizontal. 
Despite  its  extraordinary  development,  the  occipital  is  rela- 
tively small,  both  transversely  and  in  its  vertical  measurement. 
The  distance  from  the  posterior  border  of  the  foramen  mag- 
num to  the  superior  occipital  angle  is  only  103  mm. 

On  contrasting  with  any  of  the  other  crania  of  the  series, 
the  relative  shortness  of  the  occiput  is  very  noticeable.  For 
example,  Fig.  39,  which  is  a  rather  small  specimen,  distin- 
guished rather  by  the  symmetry  than  the  extent  of  its  devel- 


Pig.  33. 


opment,  shows  an  occiput  measuring  130  mm.  from  the  for- 
amen magnum  to  the  superior  angle  of  the  occipital  bone. 

Fig.  33  shows  the  inferior  surface  of  this  dolichocephalic 
specimen  and  brings  out  the  massive  development  of  the  pro- 
cesses and  muscular  attachments  at  the  base  of  the  skull.  It 
is  evident  that  the  muscles  of  the  neck  in  this  case  were  im- 
mensely powerful,  a  sine  qua  non  where  the  leverage  for 
muscular  action  is  so  short  as  in  this  particular  occiput.  The 
facial  type  in  this  specimen  is  markedly  prognathous  as  regards 
both  upper  and  lower  jaws. 

The  tout  ensemble  in  this  case  is  strongly  suggestive  of  a 
reversion  to  the  anthropoid  type,  which  is  often  the  distin- 
guishing  characteristic   of  the   degenerate  Ethiopian  type, 


140 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


criminal  or  otherwise. -'    The  following  are  the  measurements 
of  this  exceedingly  interesting  cranium: 

Horizontal  index,         .  .  .  . 

Circumference,        ----- 

Anterior  demi-circumference. 

Posterior  demi-circumference, 

Bi-zygomatic  diam.,    -  -  -  - 

Longitudinal  diam.,  -  .  .  . 

Transverse  diam.,        .  -  -  . 

Vertical  diam.  (vertex  to  foramen  magnum), 

Occipito-mental  diam., 

Bi-frontal  diam.,     -  -  -  -  - 

Bi-mastoid  diam.,         .  -  .  . 

Over  vertex,  from  ear  to  ear, 

Ant.  bord.  foramen  mag.  to  sup.  occipital  angle. 


59.9 

48.4 

c. 

21.3 

c. 

26.9 

c. 

13.3 

c. 

196.5 

mm. 

122 

mm. 

132 

mm. 

241.5 

mm. 

95 

mm. 

114 

mm. 

317 

mm. 

103 

mm. 

Fig.  34. 

The  excessive  development  of  the  jaws  and  alveolar  pro- 
cesses in  this  specimen  are  such  as  are  generally  observed  in 
the  negro  races,  in  whom  the  jaws  are  usually  well  developed 
and  rarely  deformed.  The  only  noticeable  feature  of  this  par- 
ticular specimen  is  a  high  palatal  vault. 

*  Dr.  Lydston  has  found  in  comparative  studies  of  crania  that  the  plane  of 
the  occipital  bone  is  of  some  importance  as  bearing  upon  diiferentiation.  In 
the  anthropoids  the  relative  shortness  and  horizontal  direction  of  the  occipital 
bone  is  very  striking — especially  is  this  true  of  the  basilar  process.  In  the 
degenerate  types  of  human  crania,  or,  at  least,  in  the  atavistic  types,  there 
seems  to  be  a  direct  relation  between  the  length  and  angle  of  the  basilar  pro- 
cess and  intelligence.  Dr.  Clevenger  called  attention  to  the  angle  of  the  medulla 
as  bearing  upon  intelligence,  years  ago.  but  Dr.  Lydston's  observations, 
although  confirmatory  of  those  of  Clevenger,  were  made  independently,  as  he 
had  not  had  access  to  the  work  of  the  latter. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  141 

The  next  specimen  (Fig.  34)  presents  some  extraordinary 
features.  It  is  the  skull  of  a  celebrated  negro  panel-Avorker, 
confidence-operator  and  desperado,  who,  at  the  time  of  his 
death,  was  the  consort  of  a  notorious  courtesan  who  flourished 
in  Chicago  some  years  ago. 

This  individual,  after  some  years'  dalliance  with  the  law 
without  especial  harm  to  himself,  was  finally  knifed  in  a 
brawl.  A  front  view  of  the  cranium  shows  the  ordinary  and 
characteristic  negro  facial  type,  with  the  exception,  perhaps, 
that  the  bones  are  exceptionally  massive  and  well  developed. 
A  marked  difference  is  noticed  in  the  orbits.      The  risht  is 


Fig.  35. 

nearly  round,  while  the  left  is  quite  deformed  at  its  outer 
lower  corner.  Unfortunately  the  inferior  maxilla  is  absent, 
a  fact  which  we  greatly  deplore,  as  the  general  cranial 
development  suggests  to  us  the  probability  that  the  missing 
part  presented  some  very  interesting  features  for  considera- 
tion. A  lateral  view  of  this  cranium  shows  the  ordinary 
dolichocephalic  negro  type.  The  cranial  index  is  low,  being 
72.1.  A  comparison  with  Fig.  31,  however,  shows  the 
extreme  degeneracy  of  type  in  the  latter  to  great  advantage. 
A  view  of  this  skull  (Fig.  35),  after  a  section  of  the  cal- 
varium  has  been  removed,  shows  its  most  interesting  feat- 
ures.    Skulls  of  such  extreme  thickness,  even  among  negroes. 


142 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


are  rarely  met  with.  The  consistency  of  the  bone  in  this 
cranium  is  very  dense  and  hard,  and  traditionally  this  negro, 
while  alive,  was  noted  for  his  butting  propensities.  Violent 
contact  with  such  a  skull  would  be  apt  to  damage  the  fist  of 
a  Sullivan.  Indeed,  it  is  said  that  this  fellow  rather  enjoyed 
the  impact  of  a  policeman's  club. 

We  will  state  at  this  point  that  we  are  of  the  opinion 
that  the  massiveness  of  bony  development  in  this  case  is  not 
due  to  disease.  The  general  character  of  the  overgrowth, 
and  the  consistency  of  the  bone,  would  seem  to  support  this 
view.  Syphilis  may  produce  thickening  of  the  cranial  bones, 
as  some  of  Virchow's  specimens  show,  but  syphilitic  bone 
does  not  present  the  characters  and  uniformity  present  in  this 
case. 


Fig.  36. 


At  the  densest  part  of  the  calvarium  this  specimen 
measured  13  mm.  in  thickness,  its  average  thickness  being 
11  mm.  A  comparison  with  Fig.  38  readily  shows  how  phe- 
nomenal the  osseous  development  in  this  case  is.  The 
cranial  measurements  are : 
Horizontal  index,        .  .  .  . 

Circumference,     -  -  -  - 

Anterior  demi-circumference. 
Posterior  demi-circumference,     - 
Longitudinal  diam.,    -  -  -  - 

Transverse  diam.. 

Vertical  diam.  (vertex  to  foramen  magnum), 
Bi-frontal  diam.,         -  -  -  - 


71.1 

47.8  c. 

25.4  c. 

22.4  c. 
181.5  mm. 
131      mm. 
128      mm. 

95      mm. 


THE     HEAD,    FACE,    JAWS   AND   TEETH  143 

Bi-mastoid  diam.,  -  -  -  -    113      mm. 

Bi-zygomatic  diam.,    -  -  -  -  126      mm. 

Anterior  border   of   foramen  magnum  to  sup. 

occipital  angle,       -  -  -  117       mm. 

The  upper  jaw  and  alveolar  process  in  this  skull  is  well 
developed,  the  only  peculiarity  being  a  low  palatal  vault. 

Figs.  36  and  37  show  the  skull  of  a  once  notorious  mem- 
ber of  the  Chicago  demi-monde.  She  was  a  very  tall' woman 
of  mixed  Indian  and  white  blood.  The  cephalic  index  shows 
(what  might  bd  inferred  from  the  appearance  of  the  cuts)  a 
decidedly  dolichocephalic  type,  and  a  peculiar  outline.  This 
specimen  is  the  most  symmetrically  developed  of  the  series, 
with  the  exception  of  the  Sioux  squaw  next  to  be  described, 


Pig.  37. 

and  whether  coincidental  or  not,  the  fact  remains  that  this 
subject  presented  a  higher  type  of  intellectuality  while  living 
than  any  of  the  other  subjects  embraced  in  this  essay.  The 
skull  js,  nevertheless,  of  a  degenerate  type,  as  shown  by  its 
extreme  tenuity  and  its  markedly  dolichocephalic  index.  The 
occipital  portion,  however,  is  excessively  developed. 

Fig.  38  shows  the  extreme  thinness  of  the  calvarium,  which 
was  at  the  point  of  section  only  3  mm.  in  thickness.  A  strik- 
ing feature  of  this  skull  is  its  freedom  from  prominences,  its 
surface  being  uniformly  smooth  and  rounded.  In  this  respect 
the  specimen  differs  greatly  from  another  cranium  of  a  pros- 
titute in  the  same  series  which  we  have  examined,  but  of  which, 
unfortunately,  we  have  no  illustrations.     In  this  case  there 


lU 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


was  an  excessive  development  of  the  occipital  bone,  the 
enlargement  being  symmetrical  and  most  marked  upon  the 
left  of  the  median  line.  The  right  parietal  eminence  was 
excessively  and  disproportionately  developed.  The  cranial 
index  was  markedly  dolichocephalic. 

The  principal  measurements  of  the  skull  at  present  under 
consideration  are: 

Horizontal  index,  -  -  -  -  -     67.09 

Circumference,  -  -  -  -  51.2  c. 

Anterior  demi-circumference,        -  -  -22.9  c. 

Posterior  demi-circumference,  -  -  27.3  c. 

Longitudinal  diam.,  .  .  .  .    190     mm. 


Fig.  ;-«. 


Transverse  diam.,       .  .            .            .           130.5  mm. 

Vertical  diam.,       -  -            -            -            -    128      mm. 

Bi-frontal  diam.,         -  -             -             -              88.5  mm. 

Bi-mastoid  diam.,  -  -            -            -            -      71      mm. 

Bi-zygomatic  diam.,  -  -             -             -            130      mm. 
Anterior  border  foramen  magnum   to  ant.  sup. 

occipital  angle,  .             .             -             .    hq      nm^. 

The  jaw  in  the  case  is  poorly  developed,  but  fairly  well 
formed.  In  regard  to  the  extreme  tenuity  of  the  skull,  we 
do  not  believe  that  it  is  the  result  of  pathological  change. 
The  general  lightness  of  the  bones,  and  the  symmetry  of  the 
skull,  are  not   consistent  with  the  existence  of   such   bone 


THE    HEAD,    FACE,    JAWS    AMD    TKETH  145 

changes  as  might  produce  absorption  and  thinning.  The 
markedly  dolichocephalic  type  of  this  skull  is  interesting  in 
view  of  the  strain  of  Indian  blood  in  the  subject.  As  has 
already  been  observed,  the  degenerate  type  in  dolichocephalic 
crania  is  in  the  direction  of  a  still  lower  index,  and  in  this 
instance  the  admixture  of  Indian  blood  evidently  determined 
the  degenerative  type.  This  observation  would  appear  to  be 
contradicted  by  the  case  outlined  in  Figs.  31,  32  and  33.  In 
this  case,  however,  there  was  an  admixture  of  negro  and  Mex- 
ican blood,  with  a  resultant  degeneracy  of  form  in  general  as 
well  as  in  the  cephalic  index.  This  case,  in  fact,  partakes  in 
some  respects  of  the  character  of  a  teratological  rather  than 


ii'.   39. 


an  atavistic  type,  per  se — at  least  as  far  as  the  facial  develop- 
ment is  concerned. 

A  comparison  of  the  prostitute's  skull  with  the  female 
Indian  type  next  presented  shows  a  marked  difference  in  the 
cranial  index,  the  disparity  being  7.07.  Even  the  negro  in 
Fig.  34  is  less  dolichocephalic  than  this  specimen.  The  next 
specimen,  the  cranium  of  a  full-blood  squaw  of  the  Uncpapa 
Sioux,  who  was  the  wife  of  one  of  the  leading  malcontents  in 
the  recent  Indian  outbreak,  and  consequently  of  the  better 
type  of  Indian  development. 

This  specimen  (Fig.  39)  is  exceptionally  symmetrical  and 
moderately  dolichocephalic.  Aside  from  the  purposes  of  con- 
trast, there  is  little  of  interest  to  be  said  of  it  in  connection  with 


[4:6 


ETIOLOGY  OF   08SE0US   DEFORMITIES  OF 


the  present  series.  The  subject  was  as  intelligent  as  the  bet- 
ter class  of  her  people  average,  and  there  is  nothing  to  be 
said  regarding  her  from  the  moral  standpoint.  Indeed,  as 
the  saying  goes,  the  shoe  might  be  on  the  other  foot,  as  the 
Indian  estimate  of  the  Caucasian  grave-robber  is  not  a  high 
one,  as  evidenced  l)y  his  treatment  of  the  desecrator  of  the 
Indian  burial  places  when  the  latter  happens  to  be  caught. 
However,  as  our  connection  with  the  aforesaid  desecration  is 
very  remote,  we  trust  that  our  red  brother  will  extend  his 
forgiveness. 

Fig.  iO  shows  the  same  skull  in  lateral  view.  Its  sym- 
metrical outline  is  quite  evident.  The  measurements  are  as 
follows: 


Fis.  40. 


Horizontal  index,  -  -  -  - 

Circumferential, 
Anterior  demi-circumference. 
Posterior  demi-circumference. 
Longitudinal  diam.,  .  .  _ 

Transverse  diam.,        -  .  -  . 

Vertical  diam.,       .  .  -  - 

Over  vertex  from  ear  to  ear,  - 
Occipital  protub.  to  root  of  nose, 
Bi-mastoid  diam.,        -  .  -  - 

Bi-frontal  diam.,    -  -  -  - 

Anterior  border  foramen   magnum    to   superi 
occipital  angle,      -  -  -  - 

The    superior    maxilla   presents    arrested 


-  74.  It 

► 

51.2 

c. 

-   26.6 

c. 

23.8 

c. 

-  161 

mm. 

152 

mm. 

-  140 

mm. 

318 

mm. 

-  293 

mm. 

121.5 

mm. 

-  96 

mm. 

or 

130 

mm. 

development, 

THE     HEAD,    FACE,    JAWS   AND   TEETH  147 

as  well  as  the  bones  of  the  face.  The  vault  is  of  medium 
height,  and  the  alveolar  processes  well  developed.  It  will 
be  found  that  in  the  Indian,  as  in  all  primitive  races,  a 
well-formed  palate  and  regular  teeth  are  the  rule.  It  would 
be  interesting,  at  some  future  time,  to  study  the  eifects  of 
civilization  of  the  Indian  in  this  regard. 

The  next  cranium  (Fig.  41)  which  we  will  describe  is  the 
most  remarkable  of  the  series,  and  in  many  respects  presents 
phenomenal  characters. 

The  subject  was  a  half-breed  Mexican  and  negro,  who 
had  left  Mexico,  his  native  country,  for  the  good  of  his  com- 


Pig.  41. 

patriots.  While  he  had  never  distinguished  himself  by  any 
startling  act  of  criminality,  and  had  managed  to  keep  him- 
self out  of  the  clutches  of  the  law,  he  was  identified  with 
the  petty  criminal  class  which  forms  a  prominent  portion  of 
all  social  systems,  and  with  which  Mexico  is  especially 
infested.  He  finally  died  in  a  public  hospital,  as  a  result  of 
some  acute  disease,  with  cerebral  complications.  The  gen- 
eral physique  of  this  man  was  very  fair,  although  he  pre- 
sented a  generally  overgrown  and  loose-jointed  appearance. 
When  alive  he  was  a  very  peculiar  looking  specimen  indeed, 
the  dome-shaped  appearance  of  his  cranium  being  exagger- 


lis  ,  ETIOLOGY  or  OSSEOUS   DEFOKMITIES   OF 

ated  by  a  laxuriant  crop  of  kinky  wool,  several  inches  in 
length,  that  stood  straight  out  from  his  head.  From  a  men- 
tal standpoint  he  was  up  to  the  average  of  the  negro  race, 
but,  morally  speaking,  he  was  decidedly  degenerate.  One 
of  his  prominent  characteristics  was  a  very  irritable  and 
irascible  temper. 

The  cranium,  as  is  well  shown  in  the  appended  illustra- 
tions, is  most  markedly  brachy cephalic;  indeed,  its  circum- 
ferential outline  is  almost  perfectly  round,  its  longitudinal 
and   transverse   diameters   being  nearly   equal.      The  term 


Fig.  42. 

dome-shaped  is  as  nearly  accurate  as  possible  from  a  descript- 
ive standpoint.  It  is  a  singular  fact  that  the  degenerate 
type  of  the  African  skull  often  presents  the  oxycephalic,  or 
rafter-beaded  type,  even  when  the  dolichocephalous  index  is 
pronounced.     These  rafter  heads  are  often  seen. 

The  skull  at  present  under  consideration  is,  as  already 
remarked,  a  distinctive  dome  shape,  which  corresponds  not 
at  all  with  the  rafter  head. 

The  peculiar  conformation  in  this  case  is  evidently  not  the 
result  of  pathological  conditions  or  mechanical  pressure. 
The  vault  of  the  cranium  is  quite  symmetrically  developed, 
although  the  base  of  the  skull  is  decidedly  asymmetrical,  as 


THE    HEAD,    FACE,    JAAVS    AND   TEETH  149 

will  shortly  be  shown.  We  know  of  no  mechanical  means 
which  might  have  caused  the  peculiar  dome-like  form  of  this 
specimen,  and  we  have  been  unable  to  find  mechanically 
deformed  crania  of  a  similar  type.  Such  deformities  as 
those  presented  by  the  Chinook,  or  flat-head,  Indians  are 
quite  familiar  types  of  skulls  mechanically  deformed.  Cer- 
tain specimens  found  in  ancient  Peruvian  graves  are  almost 
precisely  identical  with  the  characteristic  Chinook  type,  and 
show  a  probable  common  origin  of  the  two  races. 

There  are  several  interesting  features  in  connection  with 
the  skull  under  consideration.  One  of  the  most  striking  is 
the  extreme  shallowness  of  the  orbits.  This  is  well  shown 
by  comparison  with  some  of  the  other  types  already  described, 
the  measurements  being  one  and  three-quarters  inches  from 
the  upper  margin  of  the  orbit  to  the  optic  foramen,  while  in 
the  Indian  and  negro  skulls  in  this  series  the  orbits  measure 
two  inches  in  depth.  The  outer  walls  of  the  orbits  encroach 
upon  the  cavities,  giving  a  still  more  marked  appearance  of 
shallowness.  The  form  and  index  of  the  orbit  is  given  con- 
siderable weight  by  anthropologists  as  a  criterion  of  racial 
type.  It  is  claimed  by  Dr.  Lydston,  and  verified  by  him  by 
comparative  studies  of  orbital  development,  that  the  form  of 
the  orbit  is  of  even  greater  importance  as  bearing  upon  the 
question  of  degeneracy  of  type.  That  marked  variation  of 
the  form  and  measurements  of  the  orbit  is  incidental  to  difier- 
entiation  is  seen  by  observation  of  the  anthropoids.  There 
is  a  striking  difference  between  the  members  of  the  Simian 
group  in  this  respect,  and  a  still  greater  difference  is  notice- 
able between  the  simiidce  and  lemuridw.  The  shallowness 
and  obliquity  of  the  orbits  in  Fig.  41  is  strikingly  similar  to 
the  characters  observed  in  the  gorilla  and  chimpanzee,  which 
are  quite  different  from  those  noted  in  the  orangs.  The  gen- 
eral outline  of  the  orbits,  and  their  proportionate  relation  to 
the  facial  development,  in  Fig.  31,  are  also  decidedly  Simian 
in  character. 

The  inferior  maxilla  also  presents  some  peculiarities.  The 
coronoid  processes  are  verj'  small  and  short,  the  body  long, 
and  the  angles  very  oblique.     The  anterior  alveolar  process 


150  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

is  excessively  developed.  The  same  is  true  of  the  alveolar 
process  of  the  superior  maxilla,  it  being  so  situated  on  the 
outer  surface  of  the  jaw  that  the  teeth  were  necessarily  tipped 
in  to  facilitate  occlusion  with  the  lower  teeth.  The  central 
incisors  were  evidently  lost  in  early  life,  the  alveolus  being 
absorbed,  and  the  border  of  the  jaw  only  one-eighth  of  an 
inch  in  thickness  at  this  point.  The  palatal  vault  is  very 
low,  and  the  general  development  of  the  jaws  imperfect. 

There  is  a  marked  deflection  of  the  vomer  and  osscc  nasi, 
evidently  of  non-traumatic  origin,  and  due  to  excessive 
development  of  the  osseous  and  cartilaginous  structures  of 
the  sephim  nasi.     The  nasal  spine  is  enormously  developed. 


Fig.  4;^. 


The  cranial  index  in  this  case  is  extraordinarily  high,  being 
slightly  above  the  maximum  given  by  most  anthropologists. 
The  type  is  as  marked  in  the  direction  of  a  brachycephalic 
index  as  is  Fig,  32  in  the  direction  of  a  low,  or  dolichocepha- 
lous  index. 

Fig.  43  shows  the  inferior  surface  of  the  skull  under  con- 
sideration, A  glance  suffices  to  show  its  remarkable  asym- 
metrv.  The  foramen  magnum  is  almost  entirely  to  the  left 
of  the  median  line.  A  line  drawn  through  the  center  of  the 
foramen  traverses  the  median  line  of  this  surface  at  an  angle 
of  about  forty-five  degrees.  The  center  of  the  anterior  bor- 
der of  the  foramen  is  situated  at  76.5  mm,  from  the  left  and 
58  mm.  from  the  right  mastoid.     The  center  of  the  posterior 


THE     HEAD,    FACE,    JAW.S    AND    TEETH 


151 


border  of  the  foramen  is  64  mm.  and  61  mm.  from  the  left  and 
right  mastoids,  respectively.     The  margin  of  the  foramen  is 
extremely   thin   and   the  occipital   ridges   very  prominent. 
The  measurements  are: 


Horizontal  index, 

Circumference, 

Anterior  demi-circumference. 

Posterior  demi-circumference, 

Longitudinal  diam.,    - 


Fig.  M. 

Transverse  diam.,  -  -  -  -  - 

Vertical  diam. , 

Root  of  nose  to  occipital  protuberance,    - 

Anterior  border  foramen  mag.  to  sup.  occ.  angle, 

Bi-mastoid  diam.,  -  -  -  -  - 

Occipito-mental  diam., 

Bi-frontal  diam.,    -  -  -  -  - 

Bi-zygomatic  diam.,  -  -  -  - 

Over  vertex  from  ear  to  ear 


98.1 

46.5  c. 

22.6  c. 
23.9  c. 

146      mm. 


143  mm. 
148.5  mm. 
313      mm. 

91  mm. 
115  mm. 
248.5  mm. 

95  mm. 
133.5  mm. 
350      mm. 


On  comparing  the  longitudinal,  vertical  and  transverse 


152 


ETIOLOGY   OF   OSSEOUS  DEFORMITIES  OF 


diameters  of  this  remarlv:\l)le  skull  with  those  of  some  of  the 
others  of  the  series,  the  relatively  great  height  of  this  dome- 
like cranium  is  made  a  er}-  ap})arent.  Thus  the  diameters 
are: 

Trans.  Long. 

Fig.  31,  -    -    -  12i>  .mm.  196.5  mm. 

Fig.  34.  -  -    -    131   mm.  181   mm. 

Fig.  36,  -    -    -  130.5  mm.  190  m.m. 

Fig.  38,  -  -    -    152   mm.  161   mm. 

Fig.  47,  -    -    -  140.5  mm.  180   mm. 

Fig.  48,  -  -    -    149   mm.  168   mm. 


Vert. 

132  mm. 
128  mm. 
128  mm. 
140  mm. 
136.5  mm. 
118  mm. 


••:.^^- 


Fig.  45. 

Those  of  the  specimens  under  consideration  lieing  trans- 
verse 143  mm.,  longitudinal  146  mm.  and  vertical  148.5  mm.; 
a  comparison  with  Fig.  48  is  especially  interesting. 

While  making  some  observations  at  the  Joliet  penitentiary 
we  discovered  an  example  of  the  dome-shaped  brachycephalic 
cranium  which  strongly  resembles  the  extraordinary  speci- 
men just  described. 

This  subject  (Figs.  44  and  45)  is  a  mulatto,  about  twenty- 
three  years  of  age,  who  is  doing  time  for  attempted  murder. 
He  is  a  surly,  truculent  fellow,  of  a  low  grade  of  intelligence, 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


153 


and  inclined  to  be  unrul}'.  He  is  at  present  suflfering  from  a 
mild  type  of  syphilis.  The  form  of  the  cranium  is  well  worthy 
of  remark,  the  more  especially  as  it  so  nearly  approximates  the 
type  shown  in  Figs.  41  and  42. 

The  facial  bones,  jaws  and  teeth  in  this  case  were  extremely 
well  developed,  and  the  palatal  vault  normal.  There  was  no 
history  of  mechanical  compression,  and  as  the  subject  was 
born  in  Tennessee  such  a  cause  is  improbable,  if  not  impos- 
sible. 

The  measurements  were  not  complete.  As  far  as  taken 
they  were: 


Fig.  46. 


Horizontal  index,        -        -        -        -        -        -       76.7 

Root  of  nose  to  occ.  protuberance  over  vertex,     -     39.5  c. 
Circumference,         -         -        -        -        -        -  50.  S  c. 

Transverse  diam.,       -  -        -        _        -        .     145     nim. 

Longitudinal  diam.,  .         _         .         .         _         191     n^im. 

Occipito-f rontal  diam. ,         -----       59     mm. 

Occipito-mental  diam.,     -----  2S.5  mm. 

The  dome-like  form  of  this  cranium  will  be  more  evident 
on  comparison  of  the  two  principal  measurements  with  those 
of  a  skull  of  average  development.  A  comparison  was  made 
with  that  of  one  of  the  white  orderlies  in  the  prison  hospital, 
a  man  of  fine  physique  and  good  cranial  development.  It 
was  found  that  while  the  measurement  over  the  vertex  was 


154 


ETIOLOGY   OF   OSSKOUS  DEFORMITIES  OF 


the   same  as  that  of  the  negro,  39.5  c.,  the  circumferential 
measurement  was  58.5  c. 

The  next  specimen  (Fig.  4<i)  is  the  skull  of  a  noted 
Western  criminal  and  desperado,  who  was  lynched  for  train- 
wrecking  in  Wyoming  a  number  of  years  ago.  The  conduct 
of  this  man  during  the  progress  of  the  lynching  stamped  him 
as  a  bravo  of  the  most  hardened  type.  An  attempt  was  made 
to  induce  him  to  relate  the  particulars  of  a  murder  in  which 
he  had  participated;  the  wife  of  the  murdered  man  being 
present  at  the  hanging  and  anxious  to  learn  the  details  of  her 
husband's  death.  To  the  persuasive  efforts  of  the  '"regula- 
tors, "and  the  tears  and  entreaties  of  the  widow  of  his  victim. 


Fig.  47 


he  replied:  ''D — n  it,  you'll  hang  me  if  I  tell  and  you'll  hang 
me  if  I  don't.  So  here  goes,"  saying  which  he  deliberately 
kicked  the  barrel  upon  which  he  was  standing  out  from  under 
himself  and  thus  saved  his  self-appointed  executioners  all 
further  trouble. 

This  specimen  is  brachycephalic  and  chiefly  characterized 
by  its  marked  asymmetry. 

The  occipital  region  (Fig.  47)  in  this  cranium  is  excess- 
ively developed,  prominent  and  bulging,  being  especiall}^ 
prominent  on  the  left  of  the  median  line;  the  occipital  pro- 
tuberance is  situated  about  8  mm.  to  the  left;  the  parietal 
eminences  are  ver}-  asymmetrical,  the  right  being  very  prom- 
inent and  of  irregular  contour;  the  palatal  vault  is  of  medium 
height,  the  teeth  regular  and  the  maxilla  well  developed;  the 
measurements  are: 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


155 


Horizontal  index, 

Circumference,       -  .  .  . 

Posterior  demi-circumference, 

Tranverse  diam. ,    - 

Anterior   demi-circumference, 

Longitudinal  diam., 

Bi-f rental  diam., 

Bi-mastoid  diam., 

Bi-zygomatic  diam.,    - 

Root  of  nose  to  occipital  protuberance,     - 

Over  vertex  between  auditory  meati, 

Foramen  magnum  to  sup.  occipital  angle, 


77.  S 

50.3 

c. 

28. 6 

c. 

140. 5 

mm. 

21.9 

c. 

180 

mm. 

105 

mm. 

126 

mm, 

131 

mm. 

312 

mm. 

327.5 

mm. 

128 

mm. 

Fig.  48. 


The  next  specimen  (Fig.  48)  is  by  far  the  most  interesting 
of  the  series  from  the  standard  of  degeneracy,  and  is  certainly 
the  most  markedly  asymmetrical.  If  it  were  possible  to  con- 
ceive of  a  special  criminal  type  of  cranium,  this  would  in 
many  respects  be  an  ideal  illustration.  The  subject  was  a 
noted  Western  desperado  and  train- wrecker,  who  was  lynched 
at  Carbon,  Wyoming,  back  in  the  seventies,  for  an  attempt 
to  wreck  a  train  at  Medicine  Bow.  In  this  attempt  he  was 
assisted  by  the  individual  represented  in  Figs.  46  and  47. 

The  extremely  disproportionate  breadth  of  this  cranium 
is  well  shown  by  the  above  illustration.  The  meagre  devel- 
opment of  the  frontal  region  is  very  noticeable.     On  viewing 


156  ETIOLOGY  OF   OSSEOUS  DEFORMITIES    OF 

this  skull  from  above,  the  peculiar  twisted  appearance  which 
ma\^  be  observed  in  connection  with  the  cranial  type  of  the 
criminal  in  general  will  be  ol)served.  The  orbits  are  rela- 
tively large  and  the  face  as  a  whole  of  a  decidedly  "  squatty  " 
appearance.  The  absence  of  the  inferior  maxilla  is  to  be 
regretted,  although  considering  the  vicissitudes  which  the 
skull  has  experienced,  its  otherwise  perfect  state  of  preserva- 
tion is  rather  remarkable.  After  the  lynching  of  this  gentle- 
man the  body  was  buried  in  a  hastily  improvised  and  shallow 
grave,  from  which  it  was  very  promptly  resurrected  by  those 
scavengers  of  the  prairie,  the  coyotes.  The  skull  was  finally 
found  by  a  railroad  employe  and  subsequently  used  as  a 
paper-weight  for  some  years. 

Judging  from  the  conformation  of  the  cranial  and  facial 
bpnes,  the  lower  maxilla,  while  probably  well,  or  perhaps 
excessively  developed,  was  without  doubt  asymmetrical.  The 
relatively  defective  frontal  development  of  this  skull  is  its 
most  striking  feature  when  viewed  in  its  anterior  outline,  and 
is  best  shown  by  comparison  with  Figs.  31,  32  and  34.  In 
the  former  the  extreme  breadth  is  122  mm.  and  the  extreme 
length  196.5  mm.,  while  the  frontal  breadth  is  95  mm.  In 
the  skull  under  consideration,  however,  although  the 
extreme  breadth  is  149  mm.  and  the  extreme  length  but  171 
mm.,  the  frontal  breadth  is  only  90  mm.  The  great  dispro- 
portion in  the  measurements  is  at  once  obvious.  In  Fig.  34 
the  greatest  breadth  is  131  mm.  and  the  greatest  length  181.5 
mm.,  yet  the  tran verse  frontal  diameter  is  95  mm. 

The  disproportion  is  not  compensated  for  in  Fig.  48  by 
an  increased  longitudinal  development  of  the  frontal  bone. 

The  twisted  appearance  of  this  skull  is  most  evident  on 
comparison  of  the  parietal  eminences.  These  are  very  promi- 
nent on  both  sides,  the  left  being  much  the  larger  of  the  two; 
the  occipital  region  is  greatly  deformed  and  exceptionally 
prominent,  the  bulging  being  most  marked  upon  the  left  of 
the  median  line.  The  asymmetry  of  development  is  shown 
by  a  comparative  measurement  of  the  distance  of  each 
parietal  eminence  from  the  occipital  protuberance;  this 
measures   on    the   right   side    132  mm.  and  on  the  left  only 


THE    HEAD,    FACP],    JAWS    AND    TEETH 


157 


119  ram.  The  squatty,  animal-like  type  of  this  cranium  is 
shown  by  a  comparison  of  its  vertical  measurement  with  some 
of  the  others  of  the  series;  from  the  highest  point  at  the  vertex 
to  the  anterior  border  of  the  foramen  magnum,  the  measure- 
ment is  118  mm. ;  that  of  Fig.  32,  which  is  so  distinctively 
anthropoid  in  its  development  and  outline,  the  vertical  meas- 
urement is  132  mm.;  of  Fig.  34,  128  mm.;  of  Fig.  38,  140 
mm.;  of  Fig.  42,  148.5  mm.,  and  of  Fig.  47,  136.5  mm.  A 
little  study  of  these  measurements  will  show  the  extreme  ani- 
mality  of  type  in  this  cranium,  even  as  compared  with  others 
of  a  pronounced  degeneracy  of  type. 


Pig.  49. 


A  view  from  above  (Fig  49)  shows  the  circumferential 
outline  of  this  specimen.  By  comparing  the  quadrants  of 
this  illustration,  the  pronounced  asymmetry  of  development 
is  easily  seen. 

The  superior  maxilla  in  this  skull  is  well  developed, 
although  the  alveolar  process  shows  an  inferior  development; 
the  palatal  arch  is  exceedingly  low;  the  left  superior  maxilla 
is  much  smaller  than  the  right;  the  palatal  processes  show 
great  asymmetry,  the  right  being  61  mm.  and  the  left  but 
5  mm.  in  breadth;  the  measurements  of  this  cranium  are: 


158 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


Horizontal  index, 

Circumference,  .  _  _ 

Anterior  demi-circumference, 

Posterior  demi-circiiniference. 

Longitudinal  diam., 

Transverse  diam., 

Vertical  diam.,    -  -  -  - 

Bi-frontal  diam., 

Bi-mastoid  diam., 

Bi-zygomatic  diam. . 

Vertical  circumference  from  ear  to  ear. 


87.13 

49 

c. 

20.35 

c. 

28.65 

c. 

171 

mm. 

149 

mm. 

118 

mm 

90 

mm. 

108.5 

mm 

132 

mm 

279 

mm 

Fig.  50. 

Center  of  left  parietal   prominence  to   occipital 
protuberance,  -  -  -  119 

Center  of  right  parietal  prominence  of  occipital 
protuberance,         .  _  .  -         132 

Anterior  border  foramen   magnum  to   superior 
occipital  angle,  -  -  -  -     128 

Fig.  50  is  the  picture  of  Patrick  Eugene  Joseph  Prender- 

gast,  twenty-five  years  of   age,   who  shot  and  killed  Mayor 

Carter  Harrison  of  Chicago,  October  28,  1893,  at  his  residence, 


mm. 


mm. 


mm. 


THE     HEAD,    FACE,    JAWS   AND   TEETH  159 

claiming  that  the  mayor  had  not  given  him  a  certain  office 
which  had  been  promised  him.  Prendergast  was  born  in  Ire- 
land, and  came  to  this  country  at  the  age  of  five  years.  On 
the  witness  stand  the  author  gave  the  following  testimony: 
Height,  5  feet  7  inches.  Weight,  132  pounds.  Hair,  red, 
coarse  and  stiff;  very  little  upon  face.  Nose,  fairly  normal; 
thin  at  bridge,  broad  at  al^.  Ears,  large  and  projecting; 
lobes,  short  and  broad;  tragus,  both  well  developed;  helix, 
broad,  with  typical  tubercles  at  the  upper  and  outer  border 
of  the  ear.  Lips,  upper  small  and  thin,  lower  excessively 
developed;  more  prominent  because  of  undeveloped  upper 
jaw.  Face,  arrest  of  development  of  the  bones  of  the  face, 
especially  at  the  alae  of  the  nose.  Zygomatic  arches,  normal, 
but  appear  prominent  owing  to  the  arrest  of  the  bones  of  the 
face.  Lower  jaw,  normal.  Forehead,  receding.  Head, 
sunken  at  the  bregma;  occipital  portion  excessively  devel- 
oped; circumference,  22.2  inches  (57  mm.);  antero-posterior, 
7. 75  inches  (20  mm.);  lateral,  6.36  inches  (W^  mm.);  lateral 
index  82;  therefore  extreme  brachy cephalic.  Feet  large, 
hands  normal,  fingers  long  and  skinny.  Width,  outside  first 
permanent  molar,  2. 25  inches;  width,  outside  second  bicuspid, 
2  inches;  width  of  vault,  1.25;  height  of  vault,  .75;  antero- 
posterior, 2. 

This  individual  possesses  all  the  stigmata  of  Lombroso's 
degenerate  form  of  insanity,  paranoia. 

As  was  observed  in  the  chapter  upon  "Developmental 
Neuroses,"  that  "authors  and  specialists  differ  in  regard  to 
their  definitions  of  neurotics  and  degeneracy,  and  also  differ  as 
to  the  cases  that  should  come  under  the  head  of  one  and  the 
other, "  the  question  would  naturally  arise  (after  reviewing  the 
different  cases  under  consideration),  is  there  any  difference  ? 
We  find  the  same  deformities  in  one  that  we  do  in  the  other. 

DEFORMITIES  OF  THE  JAW  AS  SEEN  IN  CRIMINALS. 

"Although  prepared  to  find  a  goodly  proportion  of 
atypical  conformations  of  the  jaws  and  teeth  among  criminals, 
our  observations  gave  results  which  were  a  little  surprising. 

There  were  477  criminal  subjects  examined,  of  whom  4:68 


160 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES 


were  males  and  nine  females.  Of  the  whole  number  three 
were  Chinese,  eighteen  were  negroes  and  the  remainder  Avere 
w^hites,  the  latter  representing  many  nationalities. 

The  following  table  shows  the  ditt'erent  deformities  of  the 
jaws  and  teeth  that  were  found: 


^ 

o  '^ 
i2   1) 

J 

>  ^ 

j= 

_5J 

-3 

"rt 

> 

a,  ■ 

:^^ 

t-' 

-a  ^3 

5 

6 

d 

O 

1) 

2^ 

1" 

."y 

Is^ 

"s 

c3   aj 

IS 

S 

"b 

2 

Xl 

IS 

J 

Q-t 

Ch 

K 

> 

m 

:/: 

in 

c/: 

Oh 

Si 

4(i8 
'.1 

M 
F 

1(33 
9 

17 

0 

70 

13 

7'.» 

]'.) 

50 

30 

'.12 

24 

Per  cent. . 

3(5. OG 

15.72 

3 . 5(5 

1.04 

14.67 

2.70 

1(3.5(5 

3.i)8 

12.3(3 

(3.2i) 

lit.  28 

5.03 

In  the  majority  of  the  cases  the  jaws  of  the  negroes  were 
well  developed.  One  had  a  partial  V-shaped  arch,  one  a 
saddle,  one  a  V,  and  in  one  the  left  body  of  the  lower  jaw  was 
found  to  be  much  smaller  than  the  right.  The  bones  of  the 
head  and  face  were  also  well  developed.  The  three  Chinese 
were  all  sub-microcephalic,  with  very  small  jaws,  and  two  of 
the  three  had  saddle-shaped  arches.  It  is  worthy  of  note  that 
the  nine  females  examined  had  large  and  well  developed  jaws, 
with  normal  arches.'' 


CHAPTER  XI. 

PROSTITUTION  AND  SEXUAL  DEGENERACY. 

Speaking  of  the  class  under  consideration,  the  Medical 
Record  points  out  that  prostitutes  represent  a  special,  degen- 
erate, criminal  class.  They  are  more  decidedly  a  class  by 
themselves  than  professional  thieves.  Over  ten  per  cent  are 
illegitimate;  a  considerable  proportion  have  alcoholic,  syph- 
ilitic, adulterous  or  criminal  parentage.  A  large  proportion 
have  morbid  sexual  propensities,  and  crave  sexual  excesses. 
A  very  typical,  instructive  history  of  a  prostitute  is  that 
of  Alphonsine  Plessis,  idealized  by  Alexandre  Dumas  in 
"Camille."  Her  paternal  grandmother,  who  was  half  pros- 
titute, half  beggar,  gave  birth  to  a  son  by  a  country  priest. 
This  son  was  a  kind  of  country  Don  Juan,  a  peddler  by  trade. 
The  maternal  great-grandmother  was  a  nymphomaniac,  whose 
son  married  a  woman  of  loose  morals,  by  whom  a  daughter  was 
born.  This  daughter  married  the  peddler,  and  their  child  was 
Camille.  She  had,  unquestionably,  the  powerful  perverted 
sexual  instincts  of  many  of  her  class.  She  died  childless 
early  in  life  from  consumption,  nature  thus  extinguishing  the 
race.  People  with  the  ancestry,  the  habits,  the  perverse 
instincts  of  the  prostitute  class  cannot  be  cured  or  reformed 
by  the  enforcement  of  municipal  ordinances.  If  taken  from 
their  surroundings  and  placed  where  they  can  earn  an  honest 
livelihood,  they,  as  a  rule,  go  back  voluntarily  to  their  old 
mode  of  life.  And  they  do  this  despite  the  fact  that  this  life 
is  always  a  short  one,  and  is  sure  to  end  in  sickness,  degra- 
dation and  misery. 

Mrs.  Ballington  Booth,*  of  the  "salvation  army,"  discuss- 
ing the  "social  evil,"  points  out  that  a  by  no  means  small 
proportion  of  the  prostitute  class  are  illustrations  of  the 
Biblical  axiom,  that  the  "fathers  have  eaten  sour  grapes  and 
the  children's  teeth  are  set  on  edge." 

*  Quoted  by  Dr.  Harriet  C.  B.  Alexander  in  a  paper  read  before  the  Chi- 
cago Academy  of  Medicine  {Medical  Standard,  Vol.  XIII). 


102  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

Chaplain  Merrick."'  of  the  Millbank  (England)  prison,  who 
has  studied  prostitution  from  a  theological  standpoint,  arrives 
at  practically  the  same  conclusions.  Betrayal  under  promise 
of  marriage,  usually  assigned  as  the  chief  cause,  he  finds  to 
be  the  lowest  in  the  list.  Nearly  one-half  of  the  thousands 
coming  under  his  observation  left  their  homes  voluntarily  to 
take  up  "a  life  of  pleasure.''  The  most  extended  work  from 
the  purely  anthropometric  standpoint  is  that  of  Dr.  Pauline 
Tarnowsky,!  who  has  studied  150  prostitutes  in  the  Russian 
hospitals  and  prisons.  She  finds,  practically,  that  prostitu- 
tion is  crime  in  women  taking  the  line  of  least  resistance. 
The  prostitutes,  like  the  other  criminals,  are  divisible  into 
criminals  on  occasion  (vice,  monetary  reasons,  etc.),  acciden- 
tal criminals,  law-made  criminals,  weak-willed  criminals, 
periodical  criminals,  born  criminals,  and  insane  criminals. 
The  proportion  of  the  law-made  and  accidental  criminals  in 
the  demi-monde  is  much  less  than  in  the  other  classes,  as 
Chaplain  Merrick  has  shown.  Seduction  stands  very  low  in 
the  list  of  causes.  The  proportion  of  the  criminal  on  occa- 
sion type  is  very  large. 

Dr.  Tarnowsky  concludes  from  her  researches  that  the 
professional  prostitute  is  a  degenerate  being,  who  is  a  sub- 
ject of  an  arrest  of  development,  tainted  with  a  morbid 
heredity,  and  presenting  stigmata  of  physical  and  mental 
degeneracy  fully  in  consonance  with  her  imperfect  evolution. 
The  degeneracy  stigmata,  due  to  an  imperfect  organization, 
are  manifested  in  prostitutes  principally  by  the  frequency  of 
skull  deformities  (141^  per  cent),  and  deformities  of  the  face 
(42f  per  cent);  by  numerous  anomalies  of  the  ears  (42  per 
cent),  and  of  the  teeth  (54  per  cent). 

The  mental  stigmata  are  shown  in  a  more  or  less  marked 
intellectual  feebleness,  in  a  neuropathic  constitution,  in  a 
notable  absence  of  moral  sense.  It  is  also  evident  in  the 
abuse  of  genesic  functions  and  in  the  attractions  this  abject 
trade  has  for  its  subjects. 

In  order  to  determine  if  such  conditions  existed,  I  made, 

*  Journal  of  Mental  Science,  1892. 

t  '■  Etudes  Anthropoinetriques  sur  les  Prostitutees  et  les  Voleuses." 


THE    HEAD,    FACE,    JAWS   AND    TEETH  163 

together  with  Dr.  Harriet  C.  B.  Alexander  and  Dr.  J.  G.  Kier- 
nan,  some  researches  in  the  Chicago  bridewell.  The  inmates 
here  are  the  least  intelligent  of  any  of  the  class.  The 
researches  are  necessarily  far  from  complete,  owing  to  the  dif- 
ficulties under  which  such  researches  must  be  obtained  in  case 
of  persons  with  short-term  sentences.  They  were,  however, 
habitual  cases,  some  being  in  the  institution  from  time  to 
time  for  twenty  years,  and  most  of  them  criminals. 

The  number  examined  was  thirty.  Our  results  are  as 
follows: 

Race: 

Celtic-Irish,        -  -            -            -            13 

lrish-America,n,       -  -            -            -        5 

Scandinavian,    -  -            -            -              3 

German,      -            -  -            -            -        1 

German-American,  .            .            .              i 

American,   -            -  -            -            -        2 

English-American,  .            _            .              i 

Latin-Swiss,            -  -            -            -        1 

Negro,    -----  2 

These  results  tell  very  little,  as  the  "fine"  system  of 
Chicago  places  only  the  "obtuse"  class  under  imprisonment. 
One  was  seventeen  years  old,  two  eighteen  years,  one  nine- 
teen years,  five  between  twenty  and  twenty-five  years,  three 
between  twenty-five  and  thirty,  six  between  thirty  and  thirty- 
five,  five  between  thirty-five  and  forty-five,  one  was  forty-six 
years  old,  two  were  fifty-five,  three  sixty,  and  one  sixty-five. 
Neither  the  race  nor  age  data  are  of  any  value.  There  were 
eighteen  blondes,  ten  brunettes  and  two  negroes.  Four  were 
demonstrably  insane,  and  one  was  an  epileptic. 

In  sixteen  cases  the  zygomatic  processes  were  unequal  and 
very  prominent.  There  were  fourteen  other  asymmetries  of 
the  face.  Three  heads  were  Mongoloid,  one  Irish  Celt,  one 
Swiss,  and  one  Scandinavian.  There  are  Mongoloid  race 
types  in  the  regions  where  the  first  two  come.  Sixteen  were 
epignathic  and  eleven  prognathic.  In  one  there  was  arrest 
of  development  of  the  lower  jaw,  and  in  four  arrest  of  devel- 


164: 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


opment  of  the  bones  of  the  face.  The  noses  were  abnormal 
in  six. 

There  were  seventeen  brachycephalic  and  thirteen 
mesaticephalic  skulls.  There  were  no  dolichocephalic 
skulls.  There  were  three  oxycephalic  skulls,  of  whom 
one  was  a  Celt,  one  a  German,  and  one  a  Scandinavian. 
There  were  eighteen  dometype  skulls,  of  whom  seven  were 
Irish  Celts,  five  Celtic-Americans,  one  English  Anglo-Saxon, 
one  American  Anglo-Saxon,  and  one  German -American. 
There  were  four  tectocephalic  skulls,  of  Avhom  one  was  an 
Irish  Celt,  one  an  Anglo-Saxon  American,  and  one  a  Scandi- 
navian. There  were  three  platycephalic  skulls,  of  whom  two 
were  Celts  and  one  a  Scandinavian.  There  was  one  plagio- 
cephalie  German  and  a  stenocephalic  Celt.  One  skull  had  a 
protuberance  at  the  bregma.  Twelve  occiputs  were  flattened; 
in  four  of  which  there  was  no  tubercle;  eighteen  had  an 
enormously  developed  occipital  protuberance. 

The  following  table  shows  the  measurements  and  the  per- 
centage of  deformities  of  the  jaws: 


w 

•3 

t-c 

N 

a    . 

•^ 

1) 

O    u 

V 

■a 
o   p. 

3 
OS 

> 

1) 

> 

0) 

-a 

^^ 

XI    o 

r-    X> 

J2 

o. 

"c3 

> 

(U 

Cfi 

:ss 

i-S 

_b/) 

Si 

1-. 

a 

13 

u 

a 

^ 

^ 

^ 

ffi 

> 

Pm 

CO 

Pi 

in 

P-I 

zn 

Average 

2.00 

1.69 

1.06 

49 

Per   cent 

10 

17 

7 

27 

10 

10 

Twenty-nine  had  defective  ears;  eleven  were  of  the  typo 
shown  in  figure  A,  nine  of  the  type  shown  in  figure  B,  and 
nine  of  the  type  C.  The  normal  ears  were  present  in  a 
member  of  a  family  which  had  furnished  one  mother  and  two 
sisters  to  the  institution.  Five  Celtic-Irish  had  type  A,  and 
three  Celtic-Americans,  seven  Celtic-Irish,  and  one  Celtic- 
American  had  type  B.  One  Irish  Celt  and  one  American 
Celt  had  tjpe  C.  One  Celt  was  normal.  One  German  had 
type  A.   ■  One  German  and  one  German-American  had  type 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


16'5 


C.  Two  negroes  had  type  C.  One  Anglo-Saxon-American 
had  type  C,  and  one  English  Anglo-Saxon  had  type  A.  The 
three  Scandinavians  (who  were  all  more  or  less   mentally 


defective)  presented  all  three  types.  Frigerio  has  said  (cor- 
roborating a  fact  long  ago  pointed  out  by  Morel)  that  the  ear 
should  be  placed  in  the  first  rank  among  the  organs  affected 
by  degeneracy. 


166  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

Lombroso,  in  an  examination  of  fifty  prostitutes,  found 
exaggerated  lower  jaws  twenty-six  times;  plagiocephaly 
twenty-tliree  times;  asymmetrical  noses  eight  times;  prom- 
inent zygomti?  forty.  Grimaldi,  in  a  study  of  twenty-six 
prostitutes,  has  similar  results  to  those  of  Tarnowsky,  from 
whom  the  following  is  quoted: 

"  Dr.  C.  Andronico,  who,  as  sanitary  physician  at  Messina, 
had  to  deal  with  a  large  number  of  prostitutes,  is  one  of  the 
first,  at  least  to  my  knowledge,  who  has  mentioned  the  signs 
of  degeneracy  in  this  class.  He  noticed  among  230  girls,  seen 
professionall3^  the  following  anomalies: 

Flat  nose,           -            -  -            -            20 

Handle-shaped  ears,  -            -            -       35 

Vicious  implantation  of  teeth,              -            10 

Convergent  strabismus,  -            -            -        2 

Facial  asymmetry,         -  -            .              4 

Prognathism,           .  .             _             .         7 

Receding  foreheads,       -  -             -             35 

Let  us  pass  now  to  the  signs  of  bodily  degeneracy  we  have 
observed  in  professional  prostitutes. 

That  which  first  attracts  our  attention  is  the  frequency  of 
cranial  deformities  presented  by  prostitutes,  and  which  we 
have  observed  in  women  of  other  classes  in  an  incomparably 
less  degree.  These  irregularities  of  the  cranial  conformation 
reveal  themselves  in  prostitutes  by  oxycephaly,  platycephaly, 
stenocephaly,  and  plagiocephaly.*. 

Many  of  these  abnormal  crania  have  also  a  notable  devel- 
opment of  the  external  occipital  protuberance. 

Before  continuing,  I  compel  myself  to  make  a  slight 
digression;  to  say  that  while  our  observations  were  made  in  a 
hospital  especially  designed  for  the  treatment  of  venereal  dis- 
eases, there  is  no  ground  for  the  conclusion  that  syphilis  has 
had  the  least  influence  in  the  world  on  the  conformation  of 
the  crania  in  question. 

Out    of    150    prostitutes  taken   at  random   from   those 

*  Archivio  di  psiehiatria,  III,  1882,  p.  148. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  107 

answering  to  the  necessary  conditions  stated  above  (uniform- 
ity of  race,  ability  to  give  their  family  history,  and  having 
been  at  least  thirty-three  years  inmates  of  houses  of  toler- 
ance), in  these  150  prostitutes,  we  repeat,  we  have  found 
signs  of  physical  degeneracy  in  eighty-seven  per  cent. 

The  following  were  the  abnormalities  noted: 

1.  Deformities  of  the  bony  cranium,  sugar  loaf  heads — 
oxycephaly;  heads  flattened  at  the  vertex — platycephaly; 
narrow  heads,  compressed  at  the  temples — stenocephaly; 
oblique  crania — plagiocephaly;  heads  v/ith  marked  depres- 
sions or  cavities  either  in  the  region  of  the  bregma  or  that 
of  the  lambda. 

All  these  cranial  malformations  may  depend  upon  difier- 
ent  causes.  Among  the  most  probable  ones  we  will  cite 
these:  (1)  An  arrest  of  development  of  the  bone;  (2)  prema- 
ture synostosis  of  the  sutures;  (3)  pathological  processes 
occurring  during  intrauterine  life,  or  rather,  during  early 
infancy,  such  as  syphilis,  rickets,  scrofulous  affections, 
hydrocephalus,  meningitis,  etc. 

Very  recently  Professor  Kecklingshausen,  of  Strassburg. 
has  affirmed  that,  in  infant  crania,  premature  synostosis  of 
the  sutures  may  produce,  according  as  one  or  all  the  sutures 
are  involved,  either  dolichocephaly  (sagittal  suture),  trocho 
and  oxycephaly  (generalized  synostosis),  or  plagiocephaly 
(coronary  suture  of  one  side).  Professor  Kecklingshausen  also 
affirms  that  the  girth  of  the  cranium,  and  that  of  the  brain, 
influence  each  other  reciprocally,  and  that  the  form  of  the 
cranium,  especially  the  pathological  form,  is  ordinarily  the 
result  of  many  concurrent  conditions.  It  may  also  depend 
as  much  upon  disturbances  of  the  development  of  the 
sutural  synostoses,  or  of  the  bones,  as  upon  primordial 
(anomalies)  in  the  development  of  the  brain. 

The  majority  of  the  deformed  heads  of  our  prostitutes 
further  show  a  marked  development  of  the  external  occipital 
protuberance,  a  peculiarity  observed  in  one-third  of  our 
cases.  In  an  equal  number  of  virtuous  women  we  found  it 
only  five  times. 

Following  are  some  illustrations  of  badly -formed  heads: 


IGS 


ETIOLOGY    OF    OSSEOUS  DEFORMITIES  OF 


"Fig.  51.  Head  flattened  at  the  vertex;  forehead  hydro- 
cephalic; flat  nose;  lobe  of  ear  much  developed. 

Fig.  52.     Head  elevated  at  vertex;  flat  nose. 

Fig.  53.  Development  of  parietal  region  chiefly  on  one 
side. 

2.  The  anomalies  of  the  face  reveal  themselves  frequently 
by  asymmetr3%  prognathism,  and  a  sensible  disproportion 
of  dift'erent  parts;  by  a  deviation  of  the  nose,  a  deep  exca- 
vation of  the  root  of  the  nose  (nose  strongly  flattened). 
On  account  of  the  limited  number  of  our  observations,  we 
have  united  in  our  tables  of   signs  of  physical  degeneracy 


Fig.  51. 


Fig.  52. 


Fig.  53. 


these  various  anomalies  under  a  single  head,  which  we  desig- 
nate anomalies  of  the  face. 

3.  The  ogival  palatine  vault,  although  making  a  part 
of  the  facial  anomalies,  has  been  noticed  by  itself  as  a  dis- 
tinctive characteristic  sign.  We  have  been  surprised  to  see 
it  so  often. 

■1.  The  complete  division  of  the  palate.  Suture  of  the 
bones  of  the  palate  remaining  open. 

5.  Defective  teeth,  irregular  in  growth,  riding  over 
each  other,  or,  on  the  contrary,  widely  separated;  teeth 
notched  and  grooved  (Hutchinson's  and  Parrot's  teeth); 
teeth  encroaching  outside  the  dental  arch,  of  which  they 
render  the  parabola  irregular;  and  finally  the  atrophy  or  com- 


THE    HEAD,    FACE,    JAWS   AND   TEETH  169 

plete  absence  of  the  superior  lateral  incisors.  The  wisdom 
teeth  are  very  often  lacking.  In  her  excellent  thesis  of 
inauguration,  Madam  Alice  SoUier  noted  the  dental  anomal- 
ies very  common  in  the  degenerates:  "Idiocy,  with  or  with- 
out epilepsy,  predisposes  to  arrests  of  development  to 
anomalies,  and  to  lesions  of  the  dental  apparatus  in  a  large 
proportion — eighty-one  percent." 

6.  Anomalies  of  the  ear.  In  the  first  place,  we  notice 
the  badly  bordered  ear,  with  excavated  helix,  described  by 
M.  Morel.  Next,  defective  implantation  of  the  ears,  ears 
in  the  form  of  a  handle;  the  ears  with  pointed  tops,  sur- 
mounted by  the  tubercle  of  Darwin;  fleshy  ears,  with  large 
lobules,  also  ears  with  sessile  lobules. 

7.  Anomalies  of  the  extremities.  Congenital,  lack  of  one 
phalanx,  club  foot,  valgus  and  varus. 

8.  Local  asphyxia  of  the  extremities. 

All  the  anomalies  enumerated  below  are  thus  distributed 
among  150  prostitutes: 

Malformations  of  the  head  (oxycephaly,  plagiocephaly,  etc.) 
noted  in  -  -  -  -  -     62  women 

Development  of  the  occipital  protuberance,  -  62  women 

Very  receding  foreheads,  -  -  -     18  women 

Hydrocephalic,  -  -  -  -  15  women 

Various  anomalies  of  the  face  (prognathism,  asym- 
metry), -  -  -  -  -  64  women 
Ogival  palatine  vault,  -  -  -  38  women 
Congenital  division  of  palate,  -  -  -  14  women 
Vicious  implantation  of  teeth,  -  -  62  women 
Hutchinson's  and  Parrot's  teeth,  -  -  19  women 
Absence  of  lateral  incisors,  -  -  -  10  women 
Badly  margined  ears  (Morel),  -  -  -  16  women 
Defective   ears   (detached  fiom   head,   deformed, 

etc.),  -  -  .  -  .  47  women 

Anomalies  of  the  extremities,        -  -  -       8  women 

Local  asphyxia,  .  .  .  .  2  women 

It  is  evident  that  the  possessor  of  one  of  these  anomalies 
alone  should  not  be  considered  as  an  abnormal  beinof.     It  is 


170  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

only  the  coincidence  of  many  of  these  deviations  in  the  same 
person,  connected  often  with  moral  abnormalities,  that  cause 
them  to  be  regarded  as  signs  of  physical  degeneracy  and  as 
connected  with  any  hereditary  defect. 

In  our  prostitutes  these  physical  anomalies  have  been 
found  in  the  following  numbers  in  the  same  individuals: 

In  15  prostitutes,  a  single  anomaly,  or  one  in  ten  per  cent. 
In  34  prostitutes,  2  anomalies  at  once,  or  22.66  per  cent. 
In  35  prostitutes,  3  anomalies  at  once,  or  23.33  per  cent. 
In  30  prostitutes,  4  anomalies  at  once,  or  20  per  cent. 
In  14  prostitutes,  5  anomalies  at  once,  or  9.33  per  cent. 
In  66  prostitutes,  6  anomalies  at  once,  or  6  per  cent. 
In  4  prostitutes,  7  anomalies  at  once,  or  2.66  per  cent. 
In    1  prostitute,    8  anomalies  at  once,  or    0. 66  per  cent. 

Eliminating  the  first  15  women  presenting  only  one  anom- 
aly, and  who  cannot,  therefore,  be  classed  as  badly  organized 
individuals,  and  adding  one  prostitute  who  showed  no  physi- 
cal deviation,  we  find  that  the  other  134  prostitutes  show,  in 
82.6  per  cent  of  the  whole,  more  than  one  anomaly  at  the 
same  time.  In  comparison  with  these,  respectable  women, 
both  illiterate  peasants  and  cultured  females,  show  an  enor- 
mous difl^erence.  Thus,  amongst  educated  women,  we  found 
only  two  per  cent  of  anomalies,  and  amongst  illiterate  peas- 
ants, 14  per  cent. 

We  take  occasion  here  to  recall  the  fact  that  our  prosti- 
tutes were  not  especially  selected  as  they  were  admitted  to 
the  hospital;  all  were  taken  who  fulfilled  the  requirements  as 
to  race,  ability  to  furnish  the  needed  data,  and  who  were  not 
disfigured  by  syphilis. 

So  striking  a  difference  between  respectable  females  and 
prostitutes  cannot  be  merely  accidental.  We  believe  that 
such  a  notable  frequency  of  the  stigmata  of  degeneracy  in 
prostitutes  is  to  be  accounted  for,  at  least  in  great  part,  by 
their  family  histories,  which  show,  as  we  shall  see  in  the  next 
chapter,  many  of  the  causes  predisposing  to  hereditary  defect, 
as  well  as  to  arrests  of  development." 

In  concluding  this  chapter,  I  cannot  but  agree  with  the 


THE    HEAD,    FACE,    JAWS    AND   TEETH  171 

conclusions  of  Dr.  Harriet  C.  B.  Alexander,  based  on  our 
Chicago  researches,  that  the  general  propositions  of  Dr.  Tar- 
nowsky  are  borne  out  by  these  results,  albeit  degeneracy 
stigmata  are  more  frequent  among  these  Chicago  specimens. 
More  extended  researches  are  needed,  and  it  is  to  be  hoped 
that  physicians  to  allied  institutions  will  not  fail  to  cultivate 
this  field.  The  results  of  Mrs.  Ballington  Booth  and  Chap- 
lain Merrick  show  that  these  beings  need  treatment  along 
physical  lines  laid  down  in  institutions  like  the  Elmira 
reformatory.  Like  the  pauper  and  criminal,  the  prostitute 
is  an  atavistic  survival  of  primitive  states,  out  of  accord  with 
existing  tendencies,  but  arising  from  degeneracy  due  to  bad 
hygiene  and  its  resultant  moral  and  physical  effects. 

SEXUAL    DEGENERACY. 

An  allied  class,  belonging  to  a  still  blacker  phase  of  the 
night  side  of  nature,  are  the  sexual  perverts;  but  one  phase 
of  sexual  degeneracy  can  be  dealt  with  here — the  congenital 
form,  which  is  associated  with  the  stigmata  of  degeneracy  as 
an  expression  of  the  defective  line  from  which  the  victim  has 
sprung.  These  differ  in  toto  from  the  perversities  or  vice 
types  fittingly  relegated  to  the  works  on  jurisprudence.  The 
congenital  type,  as  Dr.  G.  Frank  Lydston  has  shown,  are 
victims  of  inherited  defect.  It  often  links  the  deefenerate 
lunatics,  epileptics,  etc.,  with  the  born  criminal  class. 


CHAPTER  XII. 

MORAL  INSANITY,  PAUPERISM  AND  INEBRIETY. 

There  has  formerly  been  much  discussion  of  the  subject  of 
moral  insauit}',  and  it  has  been  affirmed  and  denied  with  equal 
vehemence  that  there  existed  a  form  of  mental  disease  to 
which  the  term  "  moral  insanity  "  could  properly  be  applied. 
It  is  seen,  however,  more  recently  that  there  are  many  insane 
persons  in  whom  the  principal  difference  from  the  normal 
consists  in  disease  or  defect  of  the  moral  faculties;  while  it 
is  also  true  that  in  most  such  persons  a  closer  inspection  gen- 
erally reveals  other  signs  of  mental  disease,  defect  or  degen- 
eracy (using  the  word  "mental"  to  designate  the  whole 
mind),  besides  simply  immoral  conduct,  and  that  somatic 
signs  are  also  present.  In  such  cases,  however,  the  seeming 
immorality  is  often  the  striking  factor  of  the  case,  and  the 
mind  of  the  individual  superficially  appears  clear  and 
rational,  which  fact  led  early  writers  (Prichard,  1842,)  to  use 
the  term  in  question.  Later  a  controversy  grew  up  in  which 
one  party  protested  against  moral  insanity  being  used  as  a 
cloak  for  depravity  and  the  other  insisted  that  many  so-called 
immoral  acts  were  the  outgrowth  of  disease  or  inherent 
defect  of  the  moral  faculties.  Such  a  controversy  was  often 
bitterly  waged  by  the  opposing  sides  in  criminal  prosecu- 
tions, and  remarkable  forensic  contests  of  this  nature  have 
served  to  further  obscure  rather  than  clear  up  the  subject. 
In  some  of  these  contests  guilty  and  responsible  criminals 
have  escaped  the  consequences  of  their  crime,  while  other 
persons  innocent  from  imbecility,  chiefly  of  the  moral  facul- 
ties, have  been  unjustly  punished.  Moral  insanity  is  today 
an  accepted  form  of  disease  of  the  mind,  and  presents  features 
whereby  it  may  be  differentiated  from  depravity,  or  guilt  of 
a  responsible  individual. 

Krafft-Ebing,  a  German  writer  of  authority,  thus 
expresses  himself  with  reference  to  this  form  of  insanity: 
"If  we   seek   to  sketch  the  clinical  signs  of  this  peculiar 

172 


THE     HEAD,    FACE,    JAWS   AND   TEETH  178 

defective  state,  we  find  as  the  most  striking  appearance, 
moral  insensibility,  a  lack  of  moral  judgment  and  ethical 
ideas,  the  place  of  which  is  usurped  by  sense  of  loss  or  profit 
only  logically  apprehended.  Such  persons  may  mechanically 
know  and  remember  the  laws  of  morality,  but  if  such  laws 
enter  their  conscience  these  persons  are  not  affected  by  any 
real  appreciation,  still  less  by  regard  for  them.  These  laws 
are  cold  and  lifeless  statements,  and  the  morally  defective 
know  not  how  to  draw  from  them  any  motive  for  omission  or 
commission  of  an  act." 

To  this  "moral  color-blindness"  the  whole  moral  and 
governmental  order  appears  only  as  a  hindrance  to  egotisti- 
cal ambition  and  feeling,  which  necessarily  leads  to  negation 
of  the  rights  of  others  and  to  violation  of  the  same.  These 
defective  individuals  are  without  interest  for  aught  that  there 
is  good,  beautiful,  and  insensible  to  all  influences  of  the  heart. 
Such  persons  are  repellant  by  their  lack  of  love  for  children 
or  relatives,  and  of  all  social  inclinations,  and  by  cold-hearted 
indifference  to  the  weal  or  woe  of  those  nearest  to  them. 
They  are  without  care  for  questions  of  social  life  or  sensibil- 
ity to  either  the  respect  or  the  scorn  of  others,  without  con- 
trol of  conscience,  and  without  sense  of  remorse  for  evil. 
Morality,  they  do  not  understand.  Law  is  nothing  more 
than  police  regulations,  and  the  greatest  crime  only  the  trans- 
gression of  some  arbitrary  order.  If  such  persons  come  in 
conflict  with  individuals,  then  hatred,  envy  and  revenge  take 
the  place  of  coldness  and  negation,  and  in  their  moral  idiocy 
their  brutality  and  indifference  to  others  know  no  bounds. 

These  ethically  defective  persons,  who  are  incapable  of 
holding  a  place  in  society,  are  converted  sooner  or  later  into 
candidates  for  the  workhouse,  the  bridewell  or  the  insane 
asylums,  one  or  the  other  of  which  places  they  reach  after 
they  have  been  as  children  the  terror  of  parents  and  teachers 
through  their  untruthfulness,  laziness  and  "  general  cuss- 
edness,"  and  as  youth  the  shame  of  the  family  and  the  tor- 
ment of  the  community  and  the  officers  of  the  law  by  thefts, 
vagabondage,  profligacy  and  excesses.  Finally  they  are  the 
"despair"  of  the  asylum  and  the    "  incorrigibles "  of  the 


174  ETIOLOGY   OF  OSSEOUS   DEFORMITIES 

prison,  and,  Krafft-Ebino^  might  have  added,  the  mere  burden 
of  the  poorhouse,  since  a  hirge  number  of  them  pass  into 
fatuit}^  and  imbecility  as  a  terminal  stage  of  their  career.  It 
may  be  said  that  if  madness  or  crime  do  not  claim  them,  pau- 
perism is  almost  certainly  their  destiny. 

Physical  signs  of  defect  and  degeneracy  are  usually  to  be 
found  with  such  individuals — asymmetries,  paralysis,  mal- 
formation, especially  of  cranial  bones  and  teeth; the  facial 
expression,  the  movements  and  the  gait,  are  often  suggestive 
of  the  abnormality  of  mind.  In  a  large  majority  of  such 
cases  also,  epilepsy,  drunkenness  or  insanity  will  be  found  in 
the  ancestry. 

INEBRIETY. 

Among  ethical  degeneracies  is  naturally  included  ine- 
briety. Under  this  head  ma}'-  be  properly  classed  those 
cases  of  periodic  morbid  impulse  to  drink,  which  are  com- 
monly classed  as  dipsomaniacs.  This  morbid  state  is  best 
studied  under  two  distinct  heads — inherited  and  acquired. 
Both  conditions  may  be  associated  with  neuroses  and  degen- 
eracy. Inebriety  may  be  inherited  direct  from  the  parent,  or 
the  individual  may  have  inherited  a  neurotic  or  degenerate 
nervous  system  from  his  parents,  who  are  victims  of  other 
excesses  or  disease,  such  as  syphilis,  cancer  or  tubercular 
diathesis,  etc.  In  such  cases  the  individual,  in  almost  every 
instance,  displays  somatic  stigmata.  Such  persons,  exposed 
to  evil  influences  through  society,  soon  become  dipsomaniacs. 
Such  is  the  history  of  a  large  percentage  of  those  who  visit 
the  Keeley  institution.  There  is  properly  no  one  condition 
that  produces  so  many  forms  of  the  degenerate  in  the  oflf- 
spring  as  that  of  inebriety.  In  a  later  chapter  are  discussed 
the  results  of  this  disease. 


CHAPTER  XIII. 

INTELLECTUAL   DEGENERACY. 

Intellectual  degeneracy  reveals  itself  chiefly  under  the 
forms  of  insanity,  imbecility  and  idiocy,  and  is  often  accom- 
panied with  cranial,  facial  and  dental  irregularities.  In  addi- 
tion to  these,  the  unstable  conditions  of  the  nervous  system, 
evident  in  the  symptoms  of  idiopathic  epilepsy  or  hysteria, 
should  be  placed  in  this  same  class.  But,  simple  insanity, 
uncomplicated  mania  or  melancholia,  not  connected  with  any 
organic  lesion  or  recognized  bodily  disease,  is  not  necessarily 
connected  with  any  facial  or  cranial  defects,  nor  is  it  to  be 
considered  as  essentially  indicating  any  intellectual  degener- 
acy. Causes  sufficiently  powerful  may  produce  these  derange- 
ments in  the  brain  of  normal  individuals,  even  above  the 
average  in  mental  and  physical  vigor.  This  is  true  also  of 
the  insanities  connected  with  many  bodily  ailments,  and,  to 
some  extent,  of  delusional  insanity  or  paranoia,  and  many 
cases  of  periodical  or  remittent  insanity.  In  many  of  these 
last,  however,  and  in  some  cases  of  paranoia,  there  are  blended 
stigmata  of  degeneracy.  Of  the  developmental  insanity  of 
puberty  (adolescent  insanity  or  hebephrenia),  often  due  to 
congenital  structural  deficiencies,  the  same  is  frequently  true. 

These  cases  fall  under  the  head  of  vicious  organization,  of 
which  insanity  is  the  result.  Under  this  class  come,  per- 
haps, first,  the  degenerative  paranoiacs  (the  orighiaere  Yer- 
ruecldheit  of  the  Germans),  in  which  it  is  the  rule  to  find  mis- 
shapen crania  and  asymmetrical  features,  necessarily  involv- 
ing deformities  of  the  bony  parts,  often  extensive  and  charac- 
teristic. These  patients  are  usually  included  among  the  para- 
noiacs, but  there  is  a  wide  difierence  between  them  and  the 
typical  case  of  primary  or  secondary  delusional  insanity.  The 
born  criminals  of  Lombroso  also  fall  into  the  degenerate  class. 
They  are  the  victims  of  heredity  and  organization,  though 
none  the  less  dangerous  on  this  account.  Many  cases  of 
hysteria  also  bear  the  stigmata  of  degeneracy.     There  are 

175 


176  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

numerous  exceptions,  however.  These  are  often  impressible 
females,  unequal  to  the  stress  of  natural  physiological  require- 
ments. Whatever  stigmata  of  degeneracy  they  may  display 
are  to  be  found  in  directions  other  than  those  of  gross  defor- 
mities due  to  irregular  skeletal  development. 

The  great  neurosis,  epilepsy,  is  very  often  characterized  by 
facial  and  cranial  deformities.  Epilepsy,  in  fact,  is  only  a 
s3miptom  of  an  organic  cerebral  defect  that  very  often  reveals 
itself  in  part  by  cranial  and  facial  anomalies.  The  epileptic 
faciei  is  readily  recognized,  even  by  laymen  who  have  had 
much  to  do  with  these  unfortunates.  Dr.  H.  M.  Bannister 
tells  me  he  once  tested  this  by  a  composite  photograph  of  a 
number  of  epileptics,  taken  at  random.  Even  with  the  imper- 
fect methods  used,  the  rather  vague  photograph  was  readily 
recognized  by  a  number  of  asylum  employes  as  that  of  an  epi- 
leptic, and  by  some  mistaken  for  the  imperfect  likeness  of  a 
certain  typical  epileptic  not  included  in  the  number  who  con- 
tributed to  the  picture. 

It  is  difficult  to  say  of  just  what  this  epileptic  fades  con- 
sists, but  it  is  due  to  facial  irregularities  in  which  the  eyes  and 
jaws  largely  participate,  aside  from  the  accidents  to  which 
they  are  liable  from  their  disease,  that  frequently  produce 
deformities.  Congenital  epileptics  (especially  insane  epilep- 
tics) have  very  markedly  misshapened,  plagiocephalic  crania, 
deformed  or  ill-proportioned  jaws  and  facial  bones;  irregu- 
larities in  the  teeth  appear  to  be  very  common  among  them. 
Some  cases  of  so-called  idiopathic  epilepsy  are  probably  due 
to  traumatism  received  at  birth,  and  many  more  to  the  results 
of  natural  causes  acting  in  early  infantile  life,  especially  teeth- 
ing, often  accompanied  with  nervous  disturbances.  Often 
these  derangements  are  excessive,  and  the  yet  unformed  nerv- 
ous system  receives  a  bias  toward  instability  w^hich  affects 
the  wdiole  future  life  of  the  individual.  Infantile  convulsions 
of  the  teething  period  may  give  rise  to  epilepsy  in  the  youth 
or  adult.  Where  there  is  not  direct  passage  from  one  to  the 
other,  there  may  be  created  a  predisposition  to  the  latter  dis- 
order that  then  requires  much  less  than  the  ordinary  cause  to 
produce  it.     When  this  is  the  case,   any  later  disturbance 


THE     HEAD,    FACE,    JAWS    AND   TEETH  177 

which  would  probably  have  little  effect  on  a  normal  system, 
may  produce  the  most  serious  results.  The  second  dentition, 
which  is  not  without  its  influence  on  the  general  nervous  sys- 
tem, though  it  ordinarily  causes  little  troul)le,  may  in  indi- 
viduals thus  prepared  by  prior  instability,  especially  when 
complicated  by  anatomical  or  dental  abnormalities,  cause  epi- 
lepsy or  other  neuroses,  including  insanity.  Thus  may 
result  a  direct  connection  between  dental  and  mandibular 
deformities  and  mental  and  nervous  diseases.  The  anomalies 
of  the  jaws  and  teeth,  as  regards  their  relation  to  mental  and 
nervous  diseases,  may  be  divided  into  three  classes,  as 
follows: 

First.  Those  in  which  the  brain  symptoms  and  the  maxil- 
lary anomalies  are  both  due  to  the  same  cause,  and  are  stig- 
mata of  degeneracy  (the  deformities  as  in  idiocy,  imbecility, 
some  forms  of  systematized  and  hereditary  insanity). 

Second.  Those  in  which  the  maxillary  deformities  are  due 
and  secondary  to  the  central  disorders  (as  in  the  accidental 
deformities  of  epileptics  and  the  atrophies  observed  in  connec- 
tion with  certain  brain  lesions). 

Third.  Those  in  which  the  symptoms  involving  the  nerv- 
ous centers  are  secondary  and  consecutive  to  the  deformity 
(neuroses  from  irregular  dentition). 

The  practical  importance  of  this  last  class  will  be  readily 
appreciated.  As  dental  or  maxillary  deformities  are  dan- 
gerous in  neurotic  individuals  at  special  periods  of  life,  their 
early  correction  becomes  of  the  highest  importance.  The 
operator  must  therefore  be  able  to  recognize  these  conditions 
in  order  that  he  may  guard  against  complications.  I  know  a 
neurotic  patient,  thirteen  years  of  age,  who  developed 
epilepsy  as  a  result  of  having  her  teeth  regulated.  The 
necessary  pressure  exerted  to  remove  the  teeth  developed  the 
disease.  I  also  know  a  patient,  of  a  nervous  temperament, 
confined  to  her  bed  two  years  as  a  result  of  improper  care 
of  the  general  health  while  the  teeth  were  being  regulated. 
The  operator  failed  to  recognize  an  unstable  neurotic  temper- 
ament. These  conditions  are  very  common  at  the  period 
when  the  deformities  of  the  jaws  are  usually  corrected.     The 


ns 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


nervous  system  is  iu  a  critical  period  of  development.     This 
is  particularly  true  of  females. 

In  the  great  mass  of  the  insane  of  the  Northern  United 
States,  dental  and  maxillary  anomalies  appear  to  be  excess- 
ively frequent.  The  following  table  shows  the  results  of  the 
examination  of  the  jaws  and  teeth  of  700  insane  cases  of 
patients  taken  at  random  (without  regard  to  the  nature  of 
the  disease)  in  the  asylum  at  Dunning,  Cook  County,  Illinois: 


MAXILLARY    DEFORMITIES    AMONG   THE    INSANE. 


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In  the  next  table  we  have  the  results  of  measurements  of 
over  600  inmates  of  the  Illinois  Eastern  Hospital  for  the 
Insane  at  Kankakee,  classified  according  to  the  general  type 
of  their  disorder: 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


179 


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H-     1 

180  ETIOLOGY   OF  OSSEOUS  DEFORMITIES 

The  high  vault  is  not  conspicuous  among  those  patients. 
Some  of  the  irreguhiritics  were  due  to  local  causes,  and 
the  others  were  among  cases  of  congenitally  insane  patients, 
or  those  who  had  become  insane  early  in  life.  Most  of  the 
700  Avere  chronic  cases,  in  whom  confused  derangement  had 
followed  an  uncured  simple  insanity,  mania  or  melancholia; 
the  types,  which  as  has  already  been  stated,  are  not  neces- 
sarily or  probably  connected  with  stigmata  of  degeneracy  in 
facial  or  bony  deformities.  In  such  the  outlines  of  the  skel- 
eton are,  as  a  rule,  well  established  long  before  any  abnormal 
condition  of  the  brain  had  made  its  appearance.  Such 
patients,  in  fact,  make  up  the  greater  part  of  the  inmates  of 
public  institutions.  It  is  not  there  that  a  very  large  percent- 
age of  deformities  is  to  be  expected.  They  are  in  this  coun- 
try, especially  in  its  central  and  western  portions,  very  largely 
of  foreign  birth — normal  individuals  of  the  lower  orders  of 
society,  and  of  only  moderate  intellectual  power  and  resist- 
ance— who,  under  the  strain  of  the  struggle  for  existence  in 
new  and  often  unfavorable  conditions,  have  broken  down 
mentally.  They  are  not  necessarily  degenerates,  but  are 
mediocrities  unable  to  undergo  what  are  to  them  extraordi- 
nary conditions.  An  examination  of  these  individuals  under 
their  different  headings,  however,  may  show  a  considerable 
percentage  of  deformities.  While  many  of  these  persons  do 
not  show  stigmata  of  degeneracy  as  regards  their  jaws, 
marked  deformity  of  the  face,  ears  and  head  were  noticed  in 
those  persons  who  did  possess  deformities  of  the  jaws  and 
teeth,  showing  that  the  brain  was  defective  at  birth. 


CHAPTER  XIV. 

NEUROTICS. 

A  definition  has  already  been  given  of  the  term  '  'neurotic," 
and  mention  made  of  the  differences  of  opinion  in  regard 
to  its  signification.  The  term  neurosis  is  applied  to  a  largo 
class  of  nervous  disorders  without  a  well-defined  characteris- 
tic anatomico-pathological  basis;  and  the  word  "neurotic," 
therefore,  implies  general  indefinite  tendencies  to  nervous 
disorders  in  the  constitution  of  the  individual.  In  its  widest 
sense,  and  when  used  as  a  noun  implying  individuals,  it  may 
also  include  those  who  are  suffering  from  niinor  chronic 
nervous  ailments,  as  well  as  those  who,  from  heredity  or  oth- 
erwise, are  particularly  liable  to  disorders  of  the  nervous 
system.  In  this  sense,  a  neurotic  is  not  necessarily  a  degen- 
erate, and  while  he  may  show  some  abnormalities  in  his  phys- 
ical organization,  they  are  not  to  be  considered  as  always  and 
essentially  the  stigmata  of  degeneracy.  Thus,  deformities  of 
the  bones  are  apparently  as  common  among  neurotics  as 
among  degenerates,  and  the  same  nervous  defects  of  nutri- 
tion that  give  rise  to  them  in  one  may  produce  them  in  the 
the  other;  but  the  evidences  of  a  neurotic  constitution  do  not 
imply  any  such  general  defects  as  would  involve  the  perpet- 
uation of  the  species,  as  in  the  case  with  degeneracy.  What 
is  deficient  in  one  direction  seems  often  to  be  compensated 
for  in  another,  and  even  when  this  is  not  obviously  the  case, 
there  seems  to  be  a  resiliency  above  the  average.  Neurotics 
are  often  long-lived,  peculiarly  resistant  to  certain  acute  and 
fatal  diseases,  and  are  frequently  noticeably  retentive  of  their 
youthful  appearance,  which  is,  to  a  certain  extent,  an  evidence 
of  their  resistance  to  the  wear  and  tear  of  life  and  advancing 
old  age. 

The  fact  of  the  neurotic  tendency  often  induces  the  indi- 
vidual to  take  better  care  of  himself,  and  the  youthful 
appearance  may  be  due  largely  to  arrest  of  facial  develop- 
ment at  an  early  age,  thus  retaining  the  miniature  character 
throughout  life.  Considering,  therefore,  this  class  of  neurotics, 

181 


182  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

which  does  not  include  those  afflicted  with  the  more  serious 
nervous  disorders,  such  as  epilepsy,  they  may  be  looked  upon 
as  the  victims  of  evolutionary  processes  that  are  constantly 
eroins:  on  in  the  race  and  under  civilized  conditions.  Neu- 
rotics  are  not  met  with  to  any  extent  among  barbarous  races, 
but  are  numerous  in  civilized  communities,  where  the  weak  are 
preserved  from  early  death,  and  then  subjected  to  the  struggle 
for  existence  under  the  complicated  and  artificial  conditions  of 
modern  civilization.  Neurotics  are  naturally  imperfect  indi- 
viduals in  some  directions,  but  they  are  often  superior  in 
others.  Their  disordered  nervous  functions  and  hypera^sthe- 
sias  are  not  necessarily  indicative  of  any  inferiority  of  gen- 
eral organization.  They  may  simply  imply  a  more  rapid 
advance  in  some  one  direction  in  the  development  of  the 
nervous  system  than  can  be  readily  accommodated  to  by  the 
remainder.  These  defects  themselves  may  in  some  cases  be 
the  advance  guards  in  the  progress  of  the  development  of  the 
race.  As  the  nervous  system  controls  nutrition  in  all  depart- 
ments of  the  organism,  we  would  naturally  look  for  anoma- 
lies with  erratic  nervous  functions  in  these  individuals.  In 
these  neurotics  we  often  find  a  defective  development  involv- 
ing the  bony  and  other  structures.  They  have  fine  and  deli- 
cate features,  small  jaws,  and  defective  teeth.  These  are  the 
results  of  general  systemic  modifications  connected  with  the 
neurotic  state.  But,  besides  these,  special  nervous  disorders 
directly  aiiect  the  nutrition  of  the  jaws,  the  most  notable 
instances  of  this  being  the  diseases  called  acromegaly  and 
facial  hemiatrophy,  the  one  causing  maxillary  hypertrophy 
and  the  other  not  infrequently  unilateral  atrophy  of  the  jaw. 
In  this  connection,  also,  may  be  mentioned  the  arthritic  dia- 
thesis, which  is  one  of  the  underlying  conditions  of  many 
neurotic  manifestations,  and  which  is  responsible  for  many 
acquired  bony  deformities,  not  infrequently  involving  the 
jaws  to  some  extent. 

Overdevelopment  of  the  brain  and  nervous  system,  but 
especially  of  the  higher  brain  centers,  which  is  the  tendency 
of  modern  life,  is  not  invariably  followed  pari  passu  by  a 
corresponding  growth  of  the  other  bodily  organs  and  func- 


THE    HEAD,    FACE,    JAWS   AND   TEETH  183 

tions,  and  their  unequal  reaction  to  the  demands  of  the  higher 
organ  is  the  source  of  a  large  crop  of  neuroses.  There  is,  in 
this  way,  a  somewhat  more  remote,  but  still  probable, 
mechanical  cause  for  cranial  deformities  and  nervous  disturb- 
ances, in  the  increasing  size  of  the  infant  brain,  with  conse- 
quent enlarged  head  at  birth,  and  the  not  correspondingly 
developed  female  pelvis,  rendering  birth  more  difficult,  thus 
increasing  the  chances  of  injury  to  the  skull  and  contents, 
and  laying  the  foundation  for  future  disturbances.  Ill- 
assorted  marriages,  as  regards  mental  and  physical  character- 
istics, intermixture  of  races,  and,  more  perhaps  than  any 
other  cause,  the  excessive  strains  of  both  mind  and  body  in 
the  struggle  for  existence  in  the  existing  conditions  of  life, 
the  tendency  to  urban  residence,  with  a  resultant  artificial 
and  unnatural  condition  of  life,  immorality  and  disease,  all 
have  a  tendency  to  increase  the  number  of  neurotics  and 
degenerates,  which  is  only  partially  compensated  for  by  the 
reduced  tendency  to  intermarriage  due  to  the  migration  and 
congregation  of  large  masses  of  the  population.  There  is 
liable  to  be  less  concentrated  hereditary  taint  in  proportion 
to  the  population  than  in  quiet,  long-settled  rural  districts, 
but  there  is  a  vastly  greater  proportion  of  acquired  defects 
in  the  city  population.  It  is  in  connection  with  neurotics 
that  specialists  find  a  rich  field  for  their  investigation  of 
deformities  of  the  jaws  and  teeth  and  other  special  diseases 
of  the  eye,  ear,  nose,  throat  and  lungs.  This  class  of  indi- 
viduals are  most  common  among  the  better  classes,  although 
the  negroes  of  America  are  fast  developing  neurotic  and 
degenerate  tendencies.  The  reason  for  this  lies  in  the  fact 
that  when  weak,  sickly  children  are  born  among  the  nobility 
of  Europe,  or  of  well-to-do  people  of  Europe  or  America,  the 
family  physician  is  frequently  called,  and  the  best  of  care  is 
taken  of  them.  They  are  removed  from  one  climate  to 
another,  thus  avoiding  the  extreme  heat  and  cold  and  other 
deleterious  influences.  By  this  means  the  life  of  the  individ- 
ual is  prolonged.  In  this  way,  so  far  as  the  physical  organi- 
zation is  concerned,  we  have  an  example  of  the  survival  of  the 
unfittest.     These  people,  by  change  of  climate,  pass  the  critical 


184  .ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

point  in  yauth  and  middle  life,  and  frequently  become  our  bost 
business  men  and  women,  although  the  taint  of  disease  is  still 
lurking  in  the  system,  and  is  handed  down  from  one  genera- 
tion to  another.  Of  these  individuals,  many  possess  defect- 
ive osseous  and  nervous  systems,  which  are  either  inherited 
direct,  or  the  neurotic  or  degenerate  condition  may  be  inher- 
ited, as  the  result  of  which  arrest  or  excessive  development  of 
anj'of  the  tissues  of  the  body  may  take  place  in  the  offspring. 
Thus,  father  or  mother  may  possess  a  large  or  small  face  or 
nose,  weak  lungs,  or  abnormal  brain  development,  or  any  of 
the  conditions  noted  under  the  heads  of  nutritive,  deeren- 
eracy  and  local  reversion  tendencies;  or  on  the  other  hand,  the 
child,  by  inheriting  the  neurotic  condition  in  otherwise 
healthy  parents,  may  develop  any  of  these  conditions  at  some 
period  in  his  or  her  life.  A  few  illustrations  will  not  be  out 
of  place  at  this  time,  and  will  serve  to  impress  more  fully 
upon  the  mind  of  the  reader  the  points  which  the  author 
wishes  to  convey. 

The  cases  most  interesting  and  important  are  those  of  the 
development  of  the  child.  Neurotic  and  degenerate  symptoms 
from  a  mental  standpoint  are  noticed  long  before  deformities 
of  the  osseous  system  are  developed.  They  show  themselves 
in  the  form  of  mental  weakness,  varying  from  idiocy  to 
imbecility  and  extreme  stupidity  (m  the  one  hand,  and 
precocity  on  the  other.  Under  the  first  class,  the  child 
is  obstinate,  quarrelsome,  malignant  and  even  immorally 
inclined,  and  is  often  spoken  of  as  being  wicked  or  vicious. 
Dr.  Harriet  C.  B.  Alexander-  says  the  ruling  instinct  in  the 
child  of  three  or  four  is  self-gratification,  involved  in  which 
is  a  tendency  to  destroy  what  is  disliked.  Among  the  earli- 
est manifestations  of  morbid  mental  activity  in  childhood 
are  hallucinations  which  depend  on  already  registered  per- 
ceptions. In  many  instances  even  moral  agencies  produce 
sudden  explosions  of  mental  disorder.  The  inherited  ten- 
dencies of  childhood  predisposes  to  these  attacks.  As 
Clouston  has  shown,  neuroses  and  psychoses  not  requiring  hos- 
pital treatment  are  by  no  means  uncommon  in  the  too  sensi- 

*  The  Medical  Standard.  April,  im). 


THE    HEAD,    FACE,    JAWS    AND   TEETH  185 

tive  child  with  liereditaiy  taint.  Children  of  this  class  have 
crying  fits  and  miserable  periods  on  slight  or  no  provoca- 
tion. Cloiiston""'"  also  says  precocity,  over  sensitiveness, 
unhealthy  strictness  in  morals  and  religion  for  a  child,  a  too 
vivid  imagination^  want  of  courage,  thinness,  and  craving  for 
animal  food,  are  common  characteristics.  These  children  are 
over-sensitive,  over-imaginative,  are  too  fearful  to  be  phy- 
siological, and  tend,  as  a  general  thing,  to  be  unhealthfully 
religious,  precociously  intellectual,  and,  at  first,  hypersesthet- 
ieally  conscientious. 

The  other  class  of  children,  as  a  rule,  are  very  handsome 
babies  and  children.  Their  brightness  is  noticed  by  the 
parents  at  a  very  early  age,  and  they  extol  their  many  bright 
qualities  and  sayings.  The  tendency  is  for  the  parents  to 
cultivate  these  precocious  qualities,  and  believe  it  to  be  the 
proper  thing  to  encourage  them.  While  in  early  life  they 
may  possess  the  peculiarities  of  the  other  class,  thej^  aLso  show 
those  of  degeneracy.  These  children  are  the  best  scholars  in 
the  schoolroom  and  learn  their  lessons  with  apparently  little  or 
no  study.  They  are  usually  thin,  frail  children,  and  ver}" 
nervous.  Children  of  both  classes  are  sure  to  show  stigmata 
of  degeneracy.  This  period  of  degeneracy  commences  at 
the  sixth  year,  at  or  about  the  time  the  first  period  of  brain 
development  ceases.  The  bulk  of  the  brain  has  obtained  its 
growth.  In  some  the  cells  begin  to  develop  and  the  child 
commences  to  improve  mentally  very  fast.  In  others  mental 
development  is  slow.  In  still  others  it  ceases  altogether. 
From  the  time  the  second  set  of  teeth  begin  to  develop,  until 
the  twelfth  year,  neuroses  of  development  and  stigmata  of 
degeneracy  are  stamped  upon  the  head,  face,  nose,  jaws  and 
teeth,  and  later  an}^  of  the  conditions  mentioned  under  the 
heads  of  nutritive  degeneracy  and  local  perversion  tendencies 
may  appear.  In  a  class  of  sixty-fojir  students,  who  graduated 
with  the  author,  eleven  were  exceptionally  brilliant;  all  were 
neurotics;  most  of  them  showed  deformities  of  the  head,  face 
and  jaws.  The  attention  of  the  author  was  attracted  to  them 
because  they  always  answered   questions  in  the    "quizzes" 

*  Mental  Diseases. 


ISG  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

promptly  and  fully,  without  hesitation  or  preparation.  Onl}- 
four  of  these  men  have  made  successful  practitioners.  The  fol- 
lowing cases  are  here  mentioned  to  show  the  stigmata  trans- 
mitted to  the  children. 

NEUEOTIC  CASES. 

Case  I. — Father,  a  retired  coal  merchant,  shows  marked 
stigmata  of  degeneracy,  head  hydrocephalic,  left  eye  con- 
siderabl}^  higher  than  right,  nose  deflected  to  the  left,  face 
arrested  at  the  alae  of  the  nose,  upper  jaw  small;  is  verj- 
close  and  mean  in  his  dealings  with  others;  is  considered 
peculiar;  he  had  attended  personally  to  the  building  up  of 
his  fortune.  Mother  apparently  normally  developed.  They 
have  two  daughters ;  both  have  inherited  their  father's  head  so 
far  as  size  is  concerned;  the  upper  jaws  are  unlike.  Both 
parents  have  hypertrophy  of  the  alveolar  process.  The  old- 
est daughter,  sixteen  years  of  age,  is  unusually  bright  in 
school,  while  the  youngest  girl,  twelve  years  of  age,  is  an 
imbecile. 

Case  II. — Father,  an  exceptionally  bright  man,  well-to- 
do,  has  no  business  except  the  care  of  his  property;  spends 
most  of  his  time  doing  missionary  work;  is  of  a  nervous 
temperament;  at  one  time  became  partially  insane  upon  the 
subject  of  religion.  Mother  very  bright,  but  not  healthy; 
has  had  three  children;  oldest,  a  daughter,  died  at  the  age 
of  eighteen,  of  tuberculosis;  of  the  other  daughters,  one  six- 
teen, the  other  twelve  years  of  age;  the  one  aged  sixteen 
has  no  ambition  to  do  anything,  while  the  youngest  has 
inherited  a  nervous  temperament,  is  very  bright  at  school, 
and  a  fine  pianist.  All  the  children  possessed  deformities 
of  ttie  jaws,  face  and  teeth;  the  two  youngest  are  mouth- 
breathers. 

Case  III. — Father,  a  very  prominent  lawyer,  had  made  a 
great  deal  of  money  in  his  profession,  and  at  one  time  was  very 
wealthy,  but  being  an  indulgent  man  he  allowed  his  family 
all  the  luxuries  of  life,  consequently  his  three  children  became 
spendthrifts,  and  he  died  at  the  age  of  sixty-eight  a  poor 
man.      The  mother  was  a  very  fine  Avoman,  but  with  little 


THE    HEAD,    FACE,    JAWS    AND   TEI^TH  1 H? 

education  or  force  of  character.  The  oldest,  a  son,  an  epil- 
eptic; the  two  youngest,  daughters;  both  were  married,  but 
their  husbands  left  them;  they  were  prostitutes  before  mar- 
riage, and  have  been  going  down  hill  ever  since;  the 
youngest  has  become  insane  from  the  use  of  morphine  and 
cocaine,  and  is  now  in  the  asylum.  All  inherited  the  upper 
jaw  of  the  father,  which  was  arrested  in  its  development 
with  a  partial  V-shaped  arch. 

Case  IV. — Father,  a  minister,  of  Scotch  descent.  As  a 
preacher  is  a  success,  has  a  full  congregation  at  every  serv- 
ice. As  a  business  man  has  no  ability,  and  does  not  seem  to 
know  right  from  wrong.  In  dealing  with  people,  he  does 
not  seem  to  know  the  first  principles  of  honesty ;  it  is  diflS- 
cult  for  him  to  speak  the  truth ;  indeed,  he  forgets  all  about 
previous  obligations,  and  if  it  is  for  his  interest  to  state  a 
falsehood,  he  does  not  hesitate  to  do  so.  The  mother  is  an 
exceptionally  bright  woman;  for  five  years  used  to  write 
her  husband's  sermons.  The  minister  has  two  sisters;  one 
the  author  has  never  seen;  the  other  is  even  more  untruthful 
than  the  brother.  There  are  five  children,  three  boys  and 
two  girls;  three  of  the  children  have  myopia;  two  have 
arrest  of  development  of  the  bones  of  the  face;  two,  arrest 
of  development  of  the  superior  maxillary  bones,  with  partial 
V-shaped  arches,  one  has  inherited  the  family  trait  of  being 
very  untruthful.  The  jaws  of  father  and  mother  are  normal. 
The  neurotic  condition  of  the  children  in  this  case  inherited 
the  defective  brain  which  presided  over  and  developed  a 
defective  osseous  system. 

Two  other  similar  cases — one  a  physician,  the  other  a  trades- 
man— have  come  to  the  notice  of  the  author  in  which  the  chil- 
dren have  not  only  inherited  a  neurotic  constitution,  result- 
ing in  stigmata  of  degeneracy,  but  have  also  inherited  the 
art  of  lying.  This  inherited  trait,  or  art  of  untruthfulness, 
is  not  unlike  kleptomania. 

Case  V. — That  children  may  inherit  a  neurotic  tempera- 
ment without  apparent  cause,  is  nicely  illustrated  in  the  fol- 
lowing case:  Father,  forty-six  years  of  age;  mother  forty-two 
years;    both    perfectly    healthy,    with    the    exception    that 


188  ETIOLOGY   OF   OSSEOUS  DEFORMITIES 

the  father  has  had  sick  headache  more  or  less  all  his  life;  other- 
wise neither  has  been  sick  a  day.  Stigmata  not  noticed  in 
either  case.  There  are  two  children,  one  a  daughter, 
sixteen  years  of  age,  and  a  son,  nine  years  of  age.  The 
daughter  has,  and  will  retain  a  youthful  face;  has  arrest 
of  the  upper  jaw  and  a  V-shaped  arch;  is  unusually  bright 
at  school.  The  son  has  arrest  of  development  of  the 
bones  of  the  face;  the  teeth  are  backward  in  their  develop- 
ment, and  therefore  are  not  far  enough  advanced  to  indicate 
what  the  shape  of  the  arch  will  be.  Both  of  these  children 
have  had  scarlet  fever,  and  the  boy  has  had  a  bad  attack  of 
pneumonia.  It  is  quite  possible,  and  I  think  probable,  that 
the  neurosis,  with  the  stigmata,  is  the  result  of  these  con- 
stitutional diseases.  Both  children  are  apparently  healthy 
and  well. 


CHAPTER  XV. 

GENIUS. 

Every  city  the  world  over  has  its  brilliant  men  and  women 
journalists,  editors,  singers,  artists.  Critical  examination  by 
a  physician  woald  reveal  in  them  a  large  majority  of  neu- 
rotics, and  many  of  the  most  successful  business  men  would 
undoubtedly  be  classed  under  the  same  head.  Similar  classi- 
fication in  skilled  mechanics  would  produce  like  results.  In 
all  the  face,  jaws  and  teeth  would  bear  the  stigmata  of 
degeneracy.  To  clearly  comprehend  the  bearing  of  these 
observations,  definition  of  the  term  genius,  used  as  a  subject 
for  this  chapter,  becomes  necessary. 

Huxley  says:  "Genius  is  innate  capacity  of  any  kind 
above  the  average  mental  level";  or,  a  genius  is  one  who  is 
endowed  with  excessive  mental  development  in  some  one 
direction.  Much  has  been  written  on  genius  as  a  neurosis  or 
evidence  of  degeneracy.  If  genius  be  capacity  for  work  and 
power  of  concentrated  attention,  such  as  has  characterized 
many  of  the  world's  greatest  men,  then  it  certainly  cannot 
be  considered  a  morbid  phenomenon,  as  these  are  proper 
attributes  of  perfect  mental  and  physical  organization.  The 
average  normal  individuals,  and  indeed,  the  great  mass  of  man- 
kind fall  very  short  of  perfection  in  these  respects,  and  the 
few  who  approach  it  are  from  their  achievements  popularly 
classed  among  the  geniuses  of  the  age.  The  world  occasion- 
ally sees  an  encyclopedic  genius,  with  capacities  developed  in 
many  directions.  Admirable  Crichtons,  however,  are  so  rare 
as  to  be  merely  the  exceptions  to  the  rule,  which  proves  its 
validity,  that  great  men  are  irregularly  developed,  and  that 
the  more  brilliantly  light  is  focused  on  one  point  the  more 
apparent  the  contrast  with  the  surrounding  obscurity.  The 
defects  of  these  individuals  are  therefore  the  more  prominent. 
It  does  not  follow,  however,  that  they  are  naturally  imper- 
fect or  degenerate  individuals;  they  simply  illustrate  the  limi- 
tations of  the  human  mind,  its  inability  to  concentrate  activi- 

L89 


190  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

ties  except  in  a  narrow  sphere.  Long  continued  devotion  to 
one  line  of  study  may  destroy  or  impair  normal  capacity  in 
other  lines.  Charles  Darwin  complained  that  such  was  the 
case  with  himself;  that  in  his  later  years  he  had  become  a  mere 
machine  for  making  generalizations  upon  data  of  natural 
science. 

So  much  for  what  may  be  called  normal  geniuses,  who 
comprise  the  vast  majority,  to  say  the  least,  of  those  who 
have  done  epoch-making  work  in  the  world's  progress. 

There  is  another  class  to  whom  the  world  attributes 
genius,  and  in  many  cases  justly,  who  are  irregularly 
developed  from  the  beginning,  and  are  hence  unbalanced  and 
imperfect  individuals.  These  show  precocious  aptitude  in 
certain  directions,  and  astonish  the  world  at  once  with  their 
brilliance  and  their  erratic  performances.  These  have  often 
a  heredity  of  talent,  but  equally  often  a  heredity  of  taint. 
The  old  adage  that  ''great  wit  and  madness  are  allied"  seems 
to  be  verified  often  in  their  histories.  Inborn  talent  in  one 
direction  makes  an  irregularly  developed  individual.  If  the 
mind  in  all  other  directions  be  up  to  the  average,  this  talent 
tends  to  dwarf  the  other  faculties  by  contrast,  and  often  abso- 
lutely; the  abnormally  developed  faculties  apparently  absorb- 
ing so  much  of  nervous  force  that  in  the  other  directions  the 
physical  being  is  defective.  A  law  of  compensation  seemingl}^ 
exists  in  the  make-up  of  many  individuals — a  talent  in  one 
direction  is  balanced  by  deficiency  in  another.  In  its  extreme 
this  is  obvious  in  the  "idiot  savants,"  the  "blind  Toms,"  the 
precocious  mathematicians,  etc. 

When  the  psychic  hypertrophy  takes  a  direction  involving 
the  emotional  faculties,  as  in  the  case  of  musicians,  artists  and 
poets,  some  striking  moral  deficiency  is  often  evident,  one  of 
the  directions  in  which  failure  might  naturally  be  expected  to 
occur.  This  latter  class  of  geniuses,  possibly  the  most  numer- 
ous to  which  the  term  is  popularly  applied,  are,  to  a  certain 
extent,  examples  of  degeneracy,  and  if  the  term  genius  were 
limited  to  these  it  might  be  called  a  neurosis.  This  class  of 
individuals  is  not  limited  to  any  one  profession  or  trade,  but 
is  found  in  all  the  walks  of  life.     Any  man  who  is  above  the 


THE     HEAD,    FACE,    JAWS    AND    TEETH  191 

average  in  his  line  of  business  may  be  justifiably  termed  a 
genius. 

Men  of  genius,  as  a  rule,  arc  deficient  both  as  to  mental 
capacity  and  physically.  Nisbet*  says  that  genius,  insanity, 
idiocy,  scrofula,  rickets,  gout,  consumption,  and  other  mem- 
bers of  the  neuropathic  family  of  disorders,  are  but  so  many 
different  expressions  of  a  common  evil — an  instability  or 
Avant  of  equilibrium  in  the  nervous  system.  From  a  mental 
standpoint  men  of  genius  suffer  from  epileptic  mentality, 
melancholy,  alcoholism,  hallucinations  and  apathy,  absence 
of  moral  sense,  impulsive  tendencies,  doubting  tendencies, 
verbosity  or  excessive  taciturnity,  imbecile  vanity,  excessive 
egotism.  Physically  they  present  stigmata  like  pointed  ears, 
excessive  facial  and  head  asymmetry,  irregularities  of  the  jaws 
and  teeth,  left-handedness  and  arrest  of  development  of  the 
whole  body.  A  few  illustrations  would  not  be  out  of  place 
at  this  time. 

A  lady  of  fifty-four  comes  from  an  old  Massachussets 
family;  has  four  sisters  insane.  She  is  an  author  of  three 
books,  and  writes  for  magazines  and  journals;  she  is  very 
bright.  Some  of  her  family  have  died  insane  and  others  were 
drunkards.  She  had  taken  up  writing  in  order  that  she  might 
have  an  active  brain,  thus  preventing  her  going  insane  like 
her  sisters,  as  she  expressed  it.  She  has  arrest  of  develop- 
ment of  the  superior  maxilla.  Her  three  sons  are  all  very 
bright;  one  has  tuberculosis;  the  other  two  are  small  for  their 
age.  All  possess  arrest  of  development  of  the  jaw,  with  facial 
and  cranial  deformities. 

A  forty-two-year-old  journal  editor,  who  is  one  of  the 
most  brilliant  writers  and  talkers  I  have  had  the  pleasure  of 
meeting,  quick-witted  and  very  popular,  one  day  he  is  in  the 
best  of  spirits  and  the  next  has  the  blues  so  badly  that  his 
mood  is  felt  by  all  with  whom  he  associates.  He  has  marked 
asymmetry  of  the  face,  arrest  of  development  of  the  upper 
jaw  and  slight  protrusion  of  the  lower  jaw. 

Another  editor,  forty-eight  years  of  age,  is  also  very 
bright,  very  nervous,  has  strabismus,  very  large  head,  walks 

*  Insanity  of  genius. 


192  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

unsteady  and  a  little  to  the  side;  has  a  marked  V-shaped  jaw, 
with  arrest  of  development. 

The  president  of  one  of  the  laro^est  raih'oads  in  the  coun- 
try is  unusnally  smart  as  a  biv^iness  man;  he  has  arrest  of 
development  of  the  upper  jaw,  with  V-shaped  arch  and  a 
saddle  arch  upon  the  lower  jaw;  marked  asymmetry  of  the 
head  and  face. 

An  expert  machinist  was  oriven  the  most  difficult  work 
to  perform  in  the  shop;  his  ability  was  such  that  in  one 
instance,  he  could  take  in  the  most  difficult  situations  and 
bring  them  out  successfully ;  he  was  quite  an  inventor,  and  had 
improved  many  of  the  machines  used  in  the  shop;  his  great- 
est fault  was  that  he  was  a  periodical  drunkard,  and  frequently, 
Avhen  needed  the  most  would  be  away  drinking.  Later  years, 
when  he  was  given  difficult  pieces  of  work  to  perform  and 
Avhere  brain  work  was  required,  it  would  seem  to  unbalance 
him;  he  would  take  liquor  to  brace  him  up,  the  result  of 
which  was  that  often  before  he  was  fairly  under  way  with  his 
work  he  would  be  lying  drunk  under  his  bench.  He  was 
irregularly  built — the  lower  jaw  was  very  small,  the  upper 
arrested,  with  V-shaped  arch;  asymmetry  of  the  face,  with 
very  large,  protruding  forehead.  A  few  years  ago  an  expert 
mechanic  could  rarely  be  found  in  any  department  who  could 
be  depended  upon.  Most  of  them  were  very  unsteady  and 
periodical  drunkards. 

The  causes  which  underlie  the  development  of  genius  are 
as  interesting  as  the  study  of  the  character  itself.  Indeed,  I 
know  of  no  more  interesting  study  than  that  of  tracing  the 
history  of  great  men  from  great-grandparents  to  great-grand- 
children. In  every  instance  disease,  as  suggested  by  Nisbet 
(quoted  in  the  beginning  of  this  chapter),  is  found  associated. 
Neuroses  and  degeneracy  crop  out  in  some  form  in  each  gen- 
eration, even  more  than  in  the  average  families  that  produce 
only  mediocrities.  The  inheritance  of  genius  seems  to  be 
perilous  to  the  mental,  moral  and  physical  constitution,  and 
these  individuals  who  are  most  envied,  are  often  only  the 
most  unfortunate. 

In  one  hundred  cases  of  editors,  authors,  newspaper  men, 


THE    HEAD,    FACE,    .TAAVS    AND   TEETH  193 

professional  men  and  export  mechanics,  the  following  results 

were  obtained: 

Width  outside  first  molar,      -             -  2.15 

Width  outside  first  bicuspid,         -             -  1.62 

Width  between  second  bicuspid,        -  1,05 

Height  of  vault,     -       -     -             -             -  .51 

DEFOEMITIES   OF    THE   JAW. 

V- shape,           -             -             -             -  12 

Partial  V,  -             -             -             -             -  20 

Semi-V,             -            -            .            _  q 

Saddle,       -----  21 

Partial  saddle,              -             -             -  12 

Semi-saddle,          -             -             -             -  14 

Marked  deformities  of  the  face,          -  32 


CHAPTER  XVI. 

IDIOCY. 

Dr.  W.  W.  Ireland  has  defined  idiocy  as  ''mental  defi- 
ciency or  extreme  stupidity  depending  upon  malnutrition  or 
disease  of  the  nerve  centers,  occurring  before  birth  or  before 
the  evolution  of  the  mental  faculties  in  childhood."  A  defini- 
tion that  seems  more  inclusive,  and  that  more  clearly  describes 
the  tissues  of  the  body,  is  the  one  given  by  Dr.  Shuttleworth: 
"A  vice  of  the  entire  organism;  an  affection  not  only  of  the 
nervous  system,  but  of  the  functions  generally  of  organic 
life."  Not  a  tissue  of  the  body  is  exempt;  the  phenomena 
that  check  development  of  the  brain-tissues  will  also  interfere 
with  proper  development  of  the  other  tissues  of  the  body. 

No  part  of  the  body  has  received  the  impress  of  disease  so 
markedly  as  the  osseous  system,  and  yet,  pathologists  have 
given  this  part  of  the  idiotic  system  but  little  attention. 
This  osseous  system  seems  to  have  been  constructed  regard- 
less of  symmetry  or  uniformity.  While  in  the  normal  indi- 
vidual the  lateral  halves  are  never  uniform,  in  the  feeble- 
minded the  greatest  symmetry  prevails.  This  want  of 
harmony  is  more  apparent  in  the  maxillary  bones  because  of 
their  peculiar  formation  and  environment.  The  close  prox- 
imity of  the  jaws,  and  their  articulation,  permit  of  irregu- 
larities being  readily  observed.  At  the  beginning  of  my 
examinations  I  observed  that  other  deformities  than  the  V  and 
saddle-shaped  existed,  all  of  which  must  be  considered.  I 
found  both  excessive  and  arrested  development  of  the  maxil- 
lary bones;  arrest  of  the  one,  and  excessive  development  of 
the  other;  protrusion  of  the  upper  or  lower  jaw;  high  or  low 
vault;  partial  V  and  partial  saddle-shapped  arches;  semi-V 
and  semi-saddle-shaped  arches;  semi-V  and  semi-saddle- 
shaped  on  the  same  side,  and  small  teeth. 

Of  late  years  some  American  investigators  have  made 
examinations  among  the  inmates  of  our  institutions  for  idiots, 

194 


THE    HEAD,    FACE,    JAWS   AND   TEETH  195 

4 

and  reported  that  they  found  about  the  same  proportion  of 
irregularities  as  may  be  seen  in  ordinary  practice. 

I  believe  myself  warranted  in  the  assertion  that  a  much 
larger  percentage  of  deformities  of  the  teeth  and  jaws  exists 
among  a  given  number  of  imbeciles,  deaf  and  dumb  and  blind 
than  in  the  same  number  of  normal  individuals,  the  various 
conditions  being  the  result  either  of  arrested  development 
or  excessive  growth. 

It  is  obvious  that  any  condition  of  malnutrition,  particu- 
larly if  existing  during  the  period  of  embryonal  and  infantile 
growth  and  development,  which  is  sufficiently  marked  to 
cause  perversion  of  growth  in  the  complex  nervous  centers, 
must  necessarily  affect  the  tissues  in  general.  Nerve-tissues 
have  relatively  greater  vitality  than  the  other  tissues  of  the 
body,  and  every  physician  knows  that  the  brain  and  spinal 
cord  will  often  perform  their  functions  after  the  other  struct- 
ures of  the  body  have  been  seriously  impaired  by  disease. 

The  varying  opinions  among  scientific  men,  on  either  side 
of  the  Atlantic,  led  me  to  investigate  the  subject  carefully. 
The  examinations  were  made  by  myself  and  by  able  dentists 
in  the  following  named  institutions: 

Asylum  for  Idiots  of  the  State  of  New  York,  at  Syracuse; 
Massachusetts  School  for  Feeble-minded,  at  South  Boston; 
Illinois  Asylum  for  Feeble-minded  Children,  at  Lincoln; 
Asylum  for  Idiots,  Kandall's  Island,  N.  Y. ;  Minnesota 
Training-school  for  Idiots  and  Imbeciles,  Faribault;  Kansas 
State  Asylum  for  Idiots  and  Imbeciles,  South  Winfield;  Cook 
County  Insane  Asylum,  Dunning,  111. ;  Pennsylvania  Institu- 
tion for  Feeble-minded  Children,  at  Elwyn. 

(Special  reports  may  be  found  in  the  Transactions  of  the 
International  Medical  Congress,  187T,  and  in  the  Annual, 
1888.) 

The  following  tables  show  the  total  number  of  irregular- 
ities in  each  grade  and  sex: 


196  ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 

TOTAL   DEFORMITIES    IN    THE   JAWS.* 


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2 

1-1 

&H 

fi^ 

i-*H 

K-* 

Ph 

'Si 

CAj 

lltTT 

10<(5 

152 

!t;3 

15  It 

■.M^ 

1:.".) 

;.'3i) 

r.*07 

71 

Per  cent. . . 

55.3 

7.<) 

4.6 

7.9 

1(). 

6.5 

11.9 

10.4 

3.5 

Out  of  129  congenital  cases,  or  those  who  were  known  to 
have  become  idiotic  before  the  sixth  year,  87  per  cent  pos- 
sessed marked  deformities  of  the  face  and  jaws. 

The  above  table  shows  that  almost  one-half  of  the  whole 
number  examined  had  irregularities  of  the  jaws  and  teeth. 
The  children  examined  were  over  twelve  years  of  age.  Under 
that  age  irregularities  might  be  considered  as  of  local  origin, 
while  constitutional  and  developmental  irregularities  do  not 
appear  until  the  eruption  of  the  incisors  and  first  permanent 
molars.  As  would  be  expected,  the  largest  percentage  of 
irregularities  is  found  in  the  low-grade  class;  and  it  is  seen 
that  the  normal  classes  in  the  high  and  middle  grades  vary  only 
about  12  per  cent;  the  middle  grade  showing  the  largest  per- 
centage of  normal  jaws  and  teeth,  the  high  grade  the  next, 
and  the  low  grade  the  fewest  number  of  normal  cases. 

The  mental  capacity  of  the  idiot  can  indicate  in  a  general 
way  only  the  abnormal  condition  of  the  osseous  as  well  as 
muscular,  venous  and  arterial  systems  of  the  individual; 
thus,  a  high-grade  idiot  might  possess  an  atrophied  condition 
of  any  of  the  tissues  of  the  body,  while  a  low-grade  idiot 
might  develop  any  or  all  of  the  tissues  to  an  excessive  degree, 
this  depending,  of  course,  upon  the  inclination  and  condition 
of  the  blood-supply.  Thus  the  arterial  and  nervous  systems 
might  be  atrophied  on  one  side,  lessening  the  supply  of  blood 
to  that  side  or  limb,  and  producing  atrophy  of  the  muscular 
and  osseous  tissues  on  that  side.  The  opposite  efi'ect  might 
be  produced  on  the  other  side;  a  large  amount  of  blood  would 

*  All  tables  show  irregularities  that  are  the  result  of  small  jaws. 


THE    PIE  AD,    FACE,    JAWS   AND   TEETJI  197 

be  carried   naturally  to  the  extremities  of   the    other  side, 
causing  hypertrophy  of  tissue. 

If  these  tissues  of  the  body  are  so  prone  to  take  on  abnor- 
mal conditions,  certainly  the  jaws  must  suffer  more  or  less.  I 
have  observed  three  conditions  that  account  for  nearly  all  the 
irregularities  of  the  jaws  and  teeth:  excessive  development, 
arrest  of  development,  and  inharmonious  development  of  the 
maxillary  bones.  These  abnormalities  are  developed  with  the 
osseous  system,  and  may  be  properly  termed  constitutional, 
or  developmental. 

When  excessive  development  occurs  in  one  jaw,  and  the 
other  is  normal,  or  arrested  development  ensues,  then  the 
teeth  in  the  abnormally  large  jaw  protrude. 

If  the  cranium  is  large,  the  superior  maxilla  is  usually 
larofer  than  normal.  When  the  inferior  maxilla  is  involved, 
the  rami  are  as  likely  to  be  enlarged  as  the  body  of  the  bone. 
Sometimes  the  rami  and  the  body  develop  uniformly.  When 
there  is  excessive  development  of  a  part  or  all  of  the  bone, 
protrusion  of  the  lower  jaw  and  teeth  takes  place.  I  have  seen 
cases  in  which  one-half  of  the  superior  and  inferior  maxillae, 
as  well  as  one-half  of  the  cranium,  was  larger  than  the  other. 
In  these  irregularities  of  the  jaws,  however,  irregularities  of 
each  set  of  teeth  are  seldom  seen.  While  it  is  proper  to 
speak  of  these  conditions  as  irregularities,  yet  they  are  so  only 
as  one  jaw  is  related  to  the  other. 

I  have  already  shown,  in  a  paper  read  before  the  Dental 
Section  of  the  American  Medical  Association  in  1888,  that 
irregularities  of  the  teeth,  which  I  have  termed  constitutional, 
prevail  to  a  greater  extent  among  the  idiotic,  deaf  and  dumb, 
and  blind,  than  among  an  equal  number  of  strong  and  well- 
developed  persons;  that  not  only  is  the  brain-matter  deficient 
in  the  feeble-minded,  but  that  many  cases  are  seen  which 
show  that  the  osseous  system  is  generally  defective;  and  that 
when  the  bone-tissue  is  arrested  in  development  from  malnu- 
trition, the  maxillary  bones  are  affected. 

It  is  frequently  the  case  that  when  idiocy  appears  in  a 
family,  other  members  of  the  family  are  observed  to  be  scrof- 
ulous, deaf,  dumb,  blind,  or  insane,  showing  that  the  condi- 


198  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

tions  indicating  neurotic  tendencies  have  been  transmitted 
through  generations. 

In  his  work  on  "Insanity  in  Norway,""  Lud wig  Dahl  gives 
many  instances  in  which  the  result  of  this  tendency  is  deaf- 
ness, dumbness,  or  insanity,  as  often  as  idiocy.  He  says: 
"Acquired  insanity  and  idiocy  frequently  appear  side  by  side 
in  the  same  family  stock.  Deaf -dumbness  occurs  frequently." 
He  has  traced  the  genealogies  of  a  number  of  families,  and 
has  brought  to  light  a  number  of  interesting  facts.  In  his 
genealogy  of  No.  3,  the  Ejvinds  family  have  nine  insane  or 
idiotic,  four  deaf  and  dumb,  and  one  epileptic.  Other  families 
showed  a  similar  proportion  of  mentally  and  physically 
deformed  persons.* 

In  his  work  on  "Idiocy  and  Imbecility,"  p.  528,  Dr.  Ire- 
land says:  "Deafness  frequently  occurs  in  families  where 
some  of  the  other  members  are  idiots."  And  again  on  page 
16:  "The  children  of  epileptics  are  frequently  insane  or 
idiotic  or  hysterical,  and  the  descendants  of  an  insane  person 
are  often  epileptic,  idiotic,  or  insane.  Deaf-dumbness,  chorea, 
locomotor  ataxia,  hysteria,  and  other  disorders  of  the  nervous 
system  now  and  then  occur  in  the  descendants,  apparently  as 
the  result  of  an  inherent  neurotic  tendency  in  the  family." 

In  the  report  of  the  Commissioner  on  Idiocy  appointed  by 
the  Legislature  of  Connecticut  (see  Report  of  Commissioners 
on  Idiocy  to  the  General  Assembly  of  Connecticut,  New 
Haven,  1856,  p.  35),  it  was  found  that  out  of  seventy  cases 
of  idiocy  there  were  ten  cases  of  idiotic  parents,  six  insane 
persons,  six  insane  relatives,  eight  epileptic  parents  or  rela- 
tives, eight  blind  and  two  melancholic. 

Dr.  Howe  shows  ("On  the  Causes  of  Idiocy,"  Edinburgh, 
1858,  p.  35)  that  in  seventeen  families  in  Massachusetts  the 
heads  of  which  were  blood-relations,  there  were  born  ninety- 
five  children,  of  which  forty -four  were  idiotic,  twelve  scrofu- 
lous and  puny,  one  deaf,  and  one  a  dwarf.  Morel  and  the 
school  of  investigation  which  he  founded  point  out  that  the 
defective  classes — i.  e.,  the  congenital  deaf  mute,  blind,  luna- 

*  Lombroso  has  called  attention  to  deformities  of  the  jaws  among  the 
bom  criminals. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  199 

tic,  idiotic,  criminals,  and  paupers — are  Vjuds  on  the  same 
tree  of  human  degeneracy.  In  dealing  with  the  evidences  of 
degeneracy  they  cite  defective  teeth  as  one  of  the  signs  in 
most  instances.  These  signs  are  atavism  or  reversion  to  lower 
types  of  structure  and  function.  Many  more  cases  could  be 
given  showing  that  a  relation  exists  between  the  deaf,  dumb, 
blind,  and  insane,  but  it  is  evident  that  the  offspring  of 
parents  showing  neurotic  tendencies  and  symptoms  are  sub- 
ject to  these  conditions.  Medical  men  have  commonly  classi- 
fied these  lesions  under  the  same  head,  and  some  specialists 
go  so  far  as  to  classify  the  criminal  and  drunkard  in  this  cate- 
gory. 1  have  recently  read  an  article  from  a  French  journal 
in  which  a  left-handed  person  was  also  included. 

While  specialists  have  generally  concluded  that  most  of 
these  conditions  are  derived  from  a  common  neurotic  ancestry, 
the  only  common  feature  is  a  very  low  grade  of  cerebral 
development.  In  my  investigations,  concerning  the  osseous 
system  in  its  relations  to  the  irregularities  of  the  jaws  and 
teeth,  I  have  observed  a  lesion  common  to  all  these  conditions. 
With  this  object  in  view  I  have  made  examination  of  the 
mouths  of  all  these  classes  including  the  criminal — which  has 
been  discussed  in  a  previous  chapter.  I  found  great  difficulty 
in  enlisting  sufficient  interest  on  the  part  of  superintendents  of 
blind  asylums  to  enable  me  to  make  proper  examinations  of 
the  blind,  their  reason  being  that  the  sensitive  nature  of  the 
patients  would  not  permit  of  their  exhibiting  the  mouth 
for  examination.  I  have  conducted  a  sufficient  number  of 
examinations,  however,  to  make  some  estimate  of  the  per- 
centage of  deformities  of  the  jaws  and  teeth. 

Dr.  A.  Wilmarth,  of  the  Pennsylvania  Institution  for 
Feeble-minded  Children,  says:  "In  six  brains,  the  island  of 
Reil  was  exposed  through  the  defective  development  of  the 
third  frontal  convolution;  in  four  cases  on  two  sides,  in  two 
on  one  side  only.  In  eighteen  brains  six  were  found  where 
the  cerebrum  failed  to  cover  the  cerebellum  by  from  one- 
eighth  to  five-eighths  of  an  inch." 

I  could  quote  indefinitely  from  eminent  authorities  at  home 
and  abroad  to  show  that  not  only  are  the  different  structures 


200  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

of  the  brain  of  the  average  idiot  atrophied  and  often  entirely 
wanting,  but  that  diminution  of  weight  is  the  rule.  Enough 
cases  have  been  cited  to  give  a  general  idea  of  the  defects  in 
anatomical  structure. 

Having  determined  the  constant  relation  of  defective  cer- 
ebral development  to  idiocy,  it  remains  to  be  proven  whether 
the  defective  condition  is  a  special  one  affecting  the  brain 
only,  or  is  an  integral  part  of  the  generally  defective  or  mal- 
development,  or  at  least  of  a  general  tendency  toward  such 
perversions  of  growth.  When  w^e  take  into  consideration  the 
fact  that  the  foetus  is  developed  in  two  lateral  halves,  which 
may  or  may  not  develop  harmoniously,  and  may  or  may  not 
fuse  together  properly,  it  becomes  logical  to  presume  that 
any  influence  which  tends  to  produce  inharmony  and  asym- 
metry of  growth  in  one  part  of  the  body — e.(j.^  the  brain — 
must  necessarily  tend  to  produce  the  same  conditions  in  other 
portions  of  the  foetal  halves,  providing  such  influence  is  not  a 
purely  local  one.  The  causes  of  idiocy  not  being  local,  but 
general,  the  inference  is  obvious.  It  is  astonishing  to  me 
that  the  superintendents  of  institutions  for  the  feeble  minded 
have  made  so  little  note  of  the  asymmetrical  relations  of  the 
two  lateral  halves  of  the  body,  in  the  cases  under  their  care. 
Personally,  I  am  of  the  opinion  that  harmony  of  members 
does  not  generally  prevail  in  the  anatomy  of  the  idiot.  In 
examining  the  inmates  of  various  institutions,  I  was  struck 
with  the  numerous  examples  of  arrested  development,  hyper- 
trophy and  asymmetry  of  upper  and  lower  extremities. 
These  abnormal  conditions  accord  with  the  types  of  cerebral 
maldevelopment  already  cited. 

In  a  paper,  by  Dr.  G.  E.  Shuttleworth,  England,  presented 
before  the  International  Health  Exhibition,  London,  August 
2,  1844,  upon  "The  Health  and  Physical  Development  of 
Idiots  as  Compared  with  Mentally  Sound  Children  of  the 
same  Age,''  he  says:  "Many  idiots  are  undoubtedly  small  at 
birth;  not  a  few  have  been  brought  into  the  world  prema- 
turely, but  in  nearly  all  imperfections  of  functions  interfere 
with  due  nutrition  and  development,  as  the  following  table 
will  demonstrate: 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


201 


TABLE    SHOWING   THE    RELATI\  E    MEAN    STATUKE    AND    WEIGHT 

Of  the  General  Population,  and  of  Twelve  Hundred  and  Nine   Idiots  and 
Imbeciles  in  Earlswood,  Royal  Albert,  and  Larbert  Asylums. 


Age  last 
Birthday. 


8 

9 

10 

11 

12 

13 

14 

l.-i 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25-30 

30-40 

40-.50 

50-60 


HEIGHT. 


GENEBAL 
POPULATION. 


M 


In. 

41.00 
43.00 
45.00 
47.00 
49.00 
51.00 
53.00 
55.00 
57.50 
60.00 
62.20 
64.00 
65.50 
66.50 
67.00 
67.25 
67.. 50 


68.00 


In. 

40.55 
42.88 
44.45 
46.60 
48.73 
51.05 
53.10 
55.66 
57.77 
59.80 
60.93 
61.75 
62.52 
62.44 
62.75 
62.98 
63.03 
62.87 
63.01 
62.70 
62.02 

61.15 


IDIOTS  AND 
IMBECILES. 


M 


In. 

40.00 
42.25 
44.00 
45.75 
47.50 
49.00 
51.00 
52.. 50 
54.75 
56.. 50 
59.25 
60.75 
62.50 
63.25 
63.25 
64.00 
64.25 
64.50 


64.75 


In. 

39.. 50 
41.25 
43.25 
45.25 
47.50 
49.00 
51.00 
53.00 
55.00 
56.50 
58.00 
59.00 
59.25 


.59.50 


59. 


WEIGHT. 


GENEKAL 
POPULATION. 


M 


Lbs. 


.55.00 

60.00 

65.00 

70.00 

77.. 50 

85.00 

92.50 

102.50 

117.50 

135.00 

142.50 

143.70 

145.00 

146.20 

147.50 

148.70 

1,50.00 

151.20 

152.50 

155.00 

157.. 50 


Lbs. 

.39.20 

41.70 

47.50 

52.10 

55.50 

62.90 

68.10 

76.40 

87.20 

96.70 

106.30 

113.10 

115.50 

121.10 

123.80 

123.40 

121.80 

123.40 

124.10 

120.80 

120.00 

120.80 

118.60 

104.00 


IDIOTS  AND 
IMBECILES. 


M 


Lbs. 

39.00 

43.00 

46.50 

50.. 50 

55.50 

59.00 

64.50 

70.50 

77.00 

85.50 

94.50 

103.00 

110.00 

116.00 

120.50 

121.50 

122.00 

122. .50 


123.00 


Lbs. 

37.50 

41.00 

45.00 

49.00 

53.00 

59.00 

66.00 

72.00 

80.00 

88.00 

95.00 

102.00 

106.00 

108.00 

108.50 

108.. 50 


109.00 


"It  will  be  observed  that  idiots  are  shorter  than  the  gen- 
eral population:  at  five  years,  by  one  inch;  at  ten  years,  by 
two  inches;  at  fifteen  years,  by  three  inches;  at  twenty  years, 
by  three  inches.  While,  as  regards  weight,  male  idiots  are 
lighter  than  the  general  population — at  eight  years,  by  four 
and  one-half  pounds;  at  ten  years,  by  six  pounds;  at  fifteen 
years,  by  eight  pounds;  at  twenty  years  by  twenty-three  and 
one-half  pounds;  the  disparity  being  greater  in  the  male  than 
in  the  female  sex.  It  appears  that  the  relative  rate  of  growth 
of  the  two  sexes  of  idiot  children  follows  the  same  rule  as 
that  of  normal  children,  and  is  subject  to  the  same  variations 
at  the  age  of  pubert}^  for  two  years  preceding  which  the 
growth  of  girls  is  in  excess  of  that  of  bovs. " 


202  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

ABNORMALLY -SHAPED    HEADS. 

If  the  mental  capacity  could,  in  all  instances,  be  measured 
by  the  size  and  form  of  the  head,  many  among  the  idiotic 
would  rank  high.  The  shape  and  size  of  the  skull  are  indic- 
ative of  the  mind  only  in  a  general  way,  the  feeble-minded 
being  about  equally  divided  between  abnormally  large  and 
small  heads.  The  measurement  of  the  ordinary  well-balanced 
head  ranges  from  twenty  to  twenty-six  inches  in  circum- 
ference, and  that  of  the  idiotic  head  from  twelve  to  thirty- 
six  inches.  Opinions  vary  in  regard  to  the  average  size 
of  the  microcephalic  idiots,  some  claiming  that  all  heads 
of  sixteen  inches  and  under  come  under  this  class,  and 
others  that  thirteen  inches  in  circumference  is  the  aver- 
age microcephalic  head;  while  on  the  other  hand  all  heads 
which  measure  more  than  twenty-six  inches  in  circum- 
ference would  be  considered  either  macrocephalic  or  hydro- 
cephalic. 

The  extreme  cases  are  comparatively  few  in  the  institu- 
tions. Out  of  six  hundred  inmates  of  the  Pennsylvania 
Institution- at  Elwyn,  which  I  examined  with  the  assistance 
of  the  superintendent.  Dr.  I.  N.  Kerlin,  and  Dr.  Wilmarth,  I 
found  but  twenty-eight  microcephalic,  twenty-four  macro- 
cephalic  and  three  hydrocephalic  cases.  We  shall  find  these 
extreme  cases  exceedingly  interesting  in  the  study  of  the 
etiology  of  irregularities  of  the  teeth,  and  shall  give  special 
attention  to  their  relations  later.  There  is  a  certain  size  of 
the  head  below  which  an  individual  must  be  an  idiot.  Voisin 
says  that  ''the  proper  exercise  of  the  intellectual  qualities  is 
impossible  with  a  head  of  from  eleven  to  thirteen  inches  in 
circumference,  and  a  measurement  of  eight  to  nine  inches 
from  the  root  of  the  nose  to  the  posterior  border  of  the  occip- 
ital bone."  Irregularities  in  the  external  surface  of  the 
cranium  predominate  in  every  idiotic  head,  and  in  such 
variety  that  no  two  heads  are  found  alike.  These  conditions 
show  a  want  of  development  of  the  brain.  The  brain  sub- 
stance being  the  first  to  obtain  its  growth,  the  cranial  bones 
are  molded  about  it,  and  are,  in  a  manner,  supported  by  it 


THE    HEAD,    FACE,    JAWS   AND    TEETH  203 

until  the  sutures  have  united.  If  the  brain  be  slow  in  devel- 
oping and  shaping,  ossification  of  the  sutures  is  retarded; 
should  the  brain,  or  parts  of  it,  be  retarded  in  growth,  the 
cranium  would  be  either  microcephalic  or  asymmetrical  in  its 
development.  Again,  inharmonious  closure  of  sutures  may 
also  produce  unilateral  contractions  of  the  bones  of  the  head. 
I  do  not  wish  to  convey  the  idea,  however,  that  asymmetry 
in  the  cranium  is  always  the  result  of  malformation  of  brain- 
tissue,  as  a  certain  number  of  cases  may  result  from  arrested 
development  or  interruption  in  the  growth  of  bone  tissue. 
Per  contra.  I  am  well  aware  that  perfectly  symmetrical  heads 
are  rare  in  even  normal  individuals.  The  diagrams  in  pos- 
session of  our  hatters  tell  a  woful  tale,  not  at  all  flattering  to 
our  racial  self-conceit.  This  retarded  growth  may  result 
from  constitutional  disturbances  acting  unfavorably  upon 
general  nutrition,  or  from  inflammatory  conditions  of  the 
osteophytic  membrane,  which  may  take  place  in  utero,  thus 
prematurely  closing  the  sutures.  There  is  no  law  governing 
the  development  of  the  brain  and  the  closing  of  the  cranial 
sutures.  Those  bones,  the  sutures  of  which  close  before  the 
proper  time,  will  be  narrowed  at  the  point  of  premature 
fusion.  It  is  reasonable  to  expect  that  when  bones  prema- 
turely ossify  at  one  part  of  the  cranium,  dilatation  will  take 
place  directly  opposite,  as  the  brain  grows  in  the  direction 
of  the  least  resistance.  This  explains  many  peculiar  deform- 
ities of  the  head.  Again,  if  the  majority  of  the  sutures 
ossify  prematurely,  microcephalus  may  result.  It  appears 
reasonable,  also,  to  infer  that  the  shape  of  the  basis  cranii 
will  be  affected  in  a  similar  manner  by  too  early  or  too 
late  ossification.  These  changes  are  caused  by  improper 
nutrition  of  the  bones  and  cartilage.  A  knowledge  of  this 
fact  gives  us  a  clear  conception  of  the  relation  which  various 
general  conditions  bear  to  idiocy  and  imperfect  development 
in  general.  The  influences  of  such  perversions  of  nutrition 
as  are  produced  by  syphilis,  tuberculosis,  struma  and  intem- 
perance over  the  ossification  and  growth  of  bone  is  a  most 
patent  one.  The  same  influences  which  cause  the  shape  of  the 
base  of  the  skull,  and  the  contour  of  the  face,  do  not  depend 


204  ETIOLOGY  OF  OSSEOU8   DEFORMITIES  OF 

very  largely  upon  the  ossification  of  the  sutures.  When 
ossification  of  the  cartilages  occurs  early,  a  shortening  of 
the  basis  cranii  may  result.  Especially  is  this  the  case 
when  premature  ossification  occurs  in  connection  with  the 
sphenoid  bone.  The  age  when  the  basilar  portion  ossi- 
fies in  a  normal  subject  is  from  fifteen  to  twenty  years. 
Early  ossification  naturally  produces  a  shortening  in  the 
antero-posterior  direction,  and  also  serious  deformities  in 
the  shape  of  the  face,  and  an  abnormal  curvature  at  the 
base  of  the  brain.  The  superior  maxillary  bones  are  attached 
to  the  bones  of  the  head  and  face  by  eight  articulations, 
and  as  the  ossification  of  the  sutures  occurs  at  about  the  same 
time  as  the  ossification  of  the  sutures  of  the  basis  cranii,  the 
same  influences  which  afiect  the  cranium  must  also  affect  the 
superior  maxilla.  These  conditions  may  account  for  family 
features  not  presenting  themselves  until  middle  age.  This 
is  a  strong  argument  in  favor  of  postponing  the  operation  of 
regulating  teeth  until  the  contour  of  the  face  has  been  perma- 
nently established.  When  there  Is  inflammation  of  the  mem- 
brane in  utero  (which  is  of  common  occurrence),  the  sutures 
ossify  before  or  soon  after  birth,  and  as  a  result  the  base  of 
the  cranium  will  assume  and  remain  in  an  undeveloped  con- 
dition, causing  the  face  to  present  an  abnormal  shape  and 
size,  which  will  broaden  the  face,  throw  the  cheek  bones  out 
prominently,  make  the  nose  broad,  and  flat,  and  sunken,  and 
extend  the  space  between  the  eyes,  giving  as  a  whole  a  face 
void  of  expression.  When  the  sutures  at  the  base  of  the 
skull  ossify  normally  the  antero-posterior  diameter  is  longer, 
the  base  of  the  cranium  is  more  angular,  the  features  sharper, 
with  the  eyes  closely  set,  and  a  face  full  of  expression.  The 
sphenoid  bone  does  not  attain  its  full  size  until  from  the 
twenty-fifth  to  the  thirtieth  year  of  age. 

I  am  of  the  opinion  that,  when  the  bones  at  the  basis 
cranii  ossify  before  or  shortly  after  birth,  the  superior  maxilla 
and  septum  nasi  assume  a  decidedly  unnatural  form. 

Dr.  Oakley  Coles,  in  his  work  upon  "Deformities  of  the 
Mouth,"  ascribes  the  different  deformities  of  the  jaw  to  pre- 
mature ossification  either  of  the  sutures  or  the  basis  cranii. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  205 

Thus  he  says  that  "the  deformity  known  as  inter-maxillary 
prognathism  is  the  result  of  a  force  operating  on  the  inter- 
maxillary bone,  such  force  originating  in  the  body  of  the 
sphenoid,  and  being  transmitted  by  the  intervening  nasal 
septum."  He  says  also,  page  93:  "After  carefully  examining 
the  works  6f  various  writers  on  the  subject  of  microcephalic 
idiocy,  there  seems  sufficient  evidence  to  justify  the  belief 
that  premature  ossification  of  the  sutures  is  the  rule  in  a 
majority  of  cases  of  microcephalus,  and  we  may  therefore 
assume,  if  we  cannot  absolutely  conclude,  that  this  influence 
operates  powerfully  in  the  production  of  the  dental  deformity 
known  as  the  lambdoid  jaw"  (or  V-shaped  arch). 

While,  as  has  already  been  observed,  I  believe  that  pre- 
mature ossification  of  the  sutures  and  basis  cranii  is  followed 
by  deformities  of  the  jaw  and  septum  nasi,  I  do  not  think 
that  they  bear  to  each  other  the  relation  of  cause  and  effect. 
In  this  I  beg  leave  to  differ  with  Dr.  Coles.  It  is  unnecessary 
to  expatiate  upon  this  subject  here,  as  it  will  be  the  principal 
topic  for  discussion  in  another  chapter. 

We  have  considered  above  the  morbid  influences  of  vari- 
ous disorders  in  producing  a  vicious  condition  of  the  entire 
system  called  idiocy.  It  would  be  erroneous,  however,  to 
conclude  that  this  is  the  sole  effect  of  these  disorders,  nor  are 
excessive  and  arrested  development  limited  to  the  crania 
of  idiots,  but  they  may  be  found  in  any  portion  of  the  osseous 
system,  as  appears  from  perusing  the  literature  referred  to 
below. 

BIBLIOGRAPHY. 

1.  Hutchinson,  J.  "Arrested  Development  of  the  Radius.  Fore-arm 
and  Hand."     Tr.  Path.  Soc.  London,  1865-6,  xvii.  223,  226. 

2.  Leroy.  "Arret  de  Developpement  de  I'Avant-bras  Gauche" 
Revue  Photog.  des  Hop.  de  Paris,  1871,  iii.  80-82. 

3.  Rodenstein.  "Case  of  Arrested  Development  of  both  Upper 
Extremities."     Am.  J.  Obst.,  N.  Y.,  1876,  viii.  603-663. 

4.  Shattuck.  "Case  of  Arrested  Development  and  Growth  of  the 
Right  Upper  Limb  of  Man."     Tr.  Path.  Soc.  Lond.,  1881,  xxxii.  276-260. 

5.  Cayley,  W.  "Arrested  Development  of  Fore-arm  and  Hand."  Tr. 
Ibid.,  1865-6,  xvii.  430. 

6.  Chipperfield,  W.  N.  "Curious  Arrest  of  Development  of  the  Hand." 
Madras  Monthly  J.  M.  Soc,  1873,  vii.  409,  pi. 


206  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

7.  Doran,  A.  "A  Case  of  Arrested  Development  of  the  Bones  of  both 
Fore-arms;  Extreme  Senile  Changes  in  the  Osseous  Tissues."  Tr.  Path. 
Soc.  Lond.,  1876,  xxvii.  314,  316. 

8.  Dreyfous.  F.  "Arret  de  Developpement  du  Membre  Superieur." 
Progres  Mud.,  1878,  vi.  483. 

9.  Foucher.  "Excessive  Development  of  Left  Arm  and  Leg."  Bull. 
Soc.  Anat.  de  Paris,  1850,  xxx.  98,  108. 

10.  Hill,  A.  "Case  of  Arrested  Development  in  the  Right  Fore-arm 
of..."     Brit. -Am.  J.  M.  and  Phys.  Soc,  Montreal,  1849,  v.  119. 


CHAPTER  XVII. 

NUTRITIVE,   DEGENERATIVE,  SPINAL  AND  LOCAL 
REVERSIONAL  TENDENCIES. 

While  the  conditions  mentioned  concern  the  present  work 
but  remotely,  they  should  not  be  lost  sight  of,  since  they  are 
the  outcome  of  neuroses  and  degeneracy,  and  may  be  asso- 
ciated with  stigmata  of  degeneracy  involving  the  osseous  sys- 
tem. Most  of  them  are  allied,  and  have  been  mentioned 
throughout  this  work;  thus  lymphoid  degeneracy  predispos- 
ing to  phthisis  and  scrofula,  tissue  instability  predisposing  to 
excessive  and  arrested  development  of  tissue  have  been  fre- 
quently mentioned. 

Allied  conditions,  that  have  come  to  the  notice  of  the 
author,  may  be  mentioned  here.  A  young  man  with  a 
deformed  upper  jaw  and  face,  like  Fig.  56,  was  married  to  a 
young  lady  with  a  deformed  lower  jaw,  like  Fig.  59.  Both 
were  neurotics  and  degenerates.  At  the  end  of  two  years 
twin  girls  were  born.  Another  example:  Father  died  at 
sixty- two  years  of  cancer;  mother  still  living  at  seventj^-four 
years.  Oldest  child,  peculiar;  second,  epileptic;  third  and 
fourth  twins;  in  all,  deformities  of  the  head,  face,  jaws  and 
teeth  are  present;  all  are  boys. 

A  young  man,  successful  in  business,  was  under  my  care 
while  in  Chicago.  After  removal  of  the  tartar  from  the 
teeth  profuse  hemorrhage  of  the  gums  occurred.  After  six 
days  the  hemorrhage  was  controlled  with  great  difficulty.  He 
was  confined  to  the  house  all  the  time.  In  the  meantime  I 
learned  from  his  family  physician  that  he  had  had  two  pro- 
fuse hemorrhages,  presumably  from  the  bladder.  Two  years 
after  his  experience  with  me  his  physician  sent  him  to  Cali . 
fornia;  tuberculosis  had  set  in  and  it  was  the  only  means  of 
saving  his  life.  He  possessed  a  very  marked  V-shaped  arch, 
with  arrest  of  development  of  the  bones  of  the  face. 

A  sixteen-year-old  girl,  of  marked  neurotic  temperament, 
delicate  but  handsome  features,    bright,   and    an   excellent 

S07 


208  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

scholar,  was  taken  ill,  and  is  now  being  treated  in  a  sani- 
tarium. Her  uterus  is  undeveloped;  she  has  never  menstru- 
ated, and  is  in  a  precarious  condition;  jaws  small,  with 
V-shaped  arch. 

Two  very  interesting  cases  of  ameliac  and  polymeliac  con- 
ditions have  come  to  my  notice.  A  gentleman,  thirty-eight 
years  of  age,  once  in  business  in  Chicago,  possessed  a  face 
arrested  in  its  development,  having  the  appearance  of  a  boy 
ten  years  of  age;  jaws  small,  with  slight  protrusion  of  the 
lower;  he  was  minus  arms;  the  hands  were  developed  full 
size  near  the  shoulders.  The  second  case  was  that  of  a  mem- 
ber of  a  family  of  the  nobility  of  Spain.  The  stamp  of  degen- 
eracy was  noticeable  throughout  his  entire  body.  He  was 
short  in  stature,  with  an  excessively  developed  brain;  the 
upper  part  of  his  head  was  very  long  compared  with  the 
lower.  He  holds  a  very  responsible  government  position. 
The  jaws  were  undeveloped,  with  V-shaped  arch;  the  left  hand 
was  located  near  the  elbow. 

A  thirteen-year-old  boy,  of  Irish  descent,  with  high 
vault,  V-shaped  dental  arch,  arrest  of  superior  maxillary 
bones;  supernumerary  little  fingers  upon  left  hand. 

A  young  man,  twenty-six  years  of  age,  of  German 
parentage;  was  born  with  club-feet.  Father  died  of  consump- 
tion; mother  still  living.  This  young  man  is  an  organist; 
plays  in  church  on  Sundays  and  gives  music  lessons  during 
the  week.  He  is  a  marked  degenerate.  The  skin  is  thick, 
coarse  and  dry,  giving  him  a  very  old  appearance  on  account 
of  its  shriveled  condition.  Ears  undeveloped;  eyes  small  and 
sunken;  excessive  development  of  the  cheek-bones;  hair  coarse 
and  stiff;  face  arrested,  and  he  possesses  a  partial  V-shaped 
arch.  Width  outside  first  molar,  2;  outside  second  bicuspid, 
1.T5;  width  of  vault,  1.60;  height  of  vault,  58.  One  of  the 
prominent  features  of  degeneracy  noticed  in  this  case  is  the 
lack  of  hair  upon  the  face.  It  has  been  the  experienee  of  the 
author  that  in  nearly  every  case  of  club-feet,  stigmata  of 
degeneracy  is  stamped  upon  the  head,  face,  jaws  and  teeth. 


CHAPTER  XVIIl. 

CONSANGUINITY  OF  PARENTS. 

The  effect  of  consanguinity  of  parents  on  the  physical 
and  mental  development  of  their  offspring  is  that  of  the  con- 
centration and  reinforcement  of  hereditary  tendencies.  If 
the  heredity  is  altogether  good  and  no  incompatible  elements 
are  introduced  by  either  parent,  occasional  marriages  of  near 
relatives  would  not  be  productive  of  evil,  and  even  good 
might  result  from  the  intensification  of  desirable  qualities,  as 
we  see  it,  to  occur  in  the  close  breeding  of  fine  stock.  Huth, 
the  author  of  an  elaborate  work  on  "The  Marriage  of  Near 
Kin,"  concludes  that  the  mere  fact  of  consanguinity  of 
parents,  irrespective  of  inheritance,  in  no  way  contra-indi- 
cates  marriage.  There  are  also  some  examples  of  isolated 
communities  of  a  perfectly  healthy  stock;  for  example,  the 
Pitcairn  Islanders,  referred  to  by  Dr.  Manning,'"'  among 
whom  idiocy,  insanity  and  other  similar  degeneracies  are 
absolutely  wanting,  notwithstanding  constantly  occurring 
intermarriage  of  nearly  related  individuals.  These  people 
live,  it  is  true,  under  very  simple  and  natural  condi- 
tions, quite  different  from  those  of  the  densely  populated 
countries  or  the  centers  of  civilization.  It  is  exceedingly 
doubtful,  however,  whether  the  vitality  of  a  race  is  norm- 
ally maintained  under  close  breeding,  in  limited  localities 
especially,  even  though  physical  signs  of  degeneracy  are 
absent.  Local  intermarriages  outside  of  all  relationships, 
if  followed  up  and  practiced  too  continually,  seem  to 
have  an  unfavorable  effect,  as  has  been  noticed  in  various 
communities.  There  seems  to  be  a  general  law,  or,  at  least, 
there  is  some  reason  to  believe  there  is  one,  applying  to 
nearly  all  forms  of  animal  and  vegetable  life,  that  changes  of 
soil  and  seed  are  beneficial. 

There  are  localities  in  Europe  where  intermarriages  pro- 

*  Australia  Medical  Gazette,  1885. 

209 


21U  ETIOLOGY  OF  08SE<JUS  DEFORMITIES    OF 

diice  constantly  individuals  defective  in  constitution,  mind, 
and  limbs. ^•' 

The  incestuous  practice  of  marryins^  within  the  near  pro- 
pinquity had  long  existed  in  Spain,  with  its  normal  conse- 
quences,— dwarfing  of  the  body,  and  mental  degeneration. f 

Writers  on  lunacy  attribute  lunacy,  or  innate  idiocy,  so 
frequent  among  Scotch  families,  to  the  old  national  practice 
of  never  marrying  out  of  their  clan.;]:  The  most  degraded 
people  in  Portugal  marry  within  themselves,  and  each  gener- 
ation is  more  degraded,  which  is  also  true  in  other  countries 
of  Europe. 

In  a  county  in  South  Carolina  where  the  different  families 
intermarried  for  many  generations,  the  proportion  of  idiots 
and  deformed  is  unprecedented.  §  Mr.  Tylorjj  has  shown 
that  among  widely  different  races  in  the  most  distant  quarters 
of  the  world  marriages  between  relations — even  between  dis- 
tant relations — have  been  strictly  forbidden.  He  is  inclined 
to  attribute  this  to  the  evil  effects  of  consanguineous  mar- 
riages having  been  observed*^ 

Interbreedino:  among;  animals  is  much  closer  than  with 
the  human  race.  All  breeders  have  testified  to  the  deterio- 
ration which  arises  when  too  close  breeding  is  carried  out 
among  animals. 

Consanguinity  in  itself  counts  for  nothing,  but  acts  from 
related  organisms  having  like  constitutions,  and  being 
exposed  in  most  cases  to  similar  conditions.  Many  physiol- 
ogists attribute  the  evil  exclusively  to  the  combination  and 
consequent  increase  of  morbid  tendencies  common  to  both 
parents;  and  that  this  is  an  active  source  of  mischief  there 
can  be  no  doubt. 

The  short-horn  cattle  offer  the  most  striking  case  of  close 
interbreeding.  A  high  authority  ""'^  asserts  that  many  more 
calves  are  born  cripples  from  short-horns  than  from  other  and 

*  Smith. 

+  Sir  W.  Scott.  ••  History  of  Napoleon  Bonaparte." 

X  Percy  Hunter. 

§  Nott  and  Gliddon. 

II  "  Early  History  of  Man." 

i[  Darwin. 

**Mr.  Wright.  Journal  of  Royal  Agricull.  Soc. 


THE  HEAD,  FACE,  JAWS  AND  TEETH         211 

less  closely  interbred  races  of  cattle."  Even  in  an  unen- 
closed country  like  Paraguay,  where  there  cannot  be  such 
close  interbreeding,  there  is  an  occasional  introduction  of 
animals  from  distant  localities,  to  prevent  degeneration  in 
size  and  diminution  of  fertility,  f 

In  regard  to  deer,  as  observed  in  the  parks  of  England, 
Mr.  Shirley  concludes  that  in  some  parks,  where  there  has 
been  no  introduction  of  fresh  blood,  the  constant  breeding 
in-and-in  is  sure  to  tell  to  the  disadvantage  of  the  whole 
herd.:|; 

The  offspring  of  strong  spaniels  degenerate  into  weak  and 
diminutive  lap-dogs,  when  bred  in-and-in.  In  the  case  of 
pigs,  long-continued  and  close  interbreeding  does  not  affect 
the  external  form  or  merit  of  the  young;  but  with  many  of 
them  the  general  constitution  and  mental  powers  were  seri- 
ously affected;  in  some  cases  idiots  were  produced.* 

That  consanguineous  marriages  have  a  very  demoralizing 
effect  upon  posterity,  is  a  well-known  fact  to  all  scientists  and 
physicians.  The  results  are  very  marked  in  the  nobility  of 
Europe.  The  mental  wrecks  as  well  as  the  physical  condi- 
tion of  many  of  these  royal  heads  are  illustrations  of  inter- 
marriage among  near  relatives.  It  is  claimed  by  dentists 
that  excessive  or  arrested  development  and  irregularities  of 
the  teeth  are  more  common  among  royalty  than  among  the 
masses.  It  is  very  common  to  find  children  born  of  cousins 
and  near  relations  in  this  country  defective  in  body  and  limb. 
When  the  brain  is  involved,  we  have  two  factors  which 
assist  in  producing  excessive  or  arrested  development  of  the 
jaws:  First,  direct  inherited  tendencies,  such  as  a  large  or 
small  jaw;  and  second,  defective  development  due  to  neur- 
oses. These  deformities  are  very  marked  among  the 
Hebrews,  with  whom  intermarriages  are  very  common. 
Thus,  in  the  Hebrew  Orphan  Asylum,  New  York  City,  only 
seventy-four  per  cent  of  the  inmates  had  normal  jaws.§ 

Consanguineous  marriages  not  infrequently  result  in  men- 

*  Darwin. 

t  Azara,  "  Quadrupedes  du  Paraguay." 

X  Mr.  Seebright. 

§  Mr.  Wright. 


212  ETIOLOGY  OF  OSSEOU8   DEFORMITIES  OF 

tal  aberrations  in  the  progeny.  Dr.  Howe  states  that  in 
seventeen  families,  the  heads  of  which  were  related  by  blood 
and  intermarriage,  the  result  was  fearful.  Most  of  the 
parents  were  intemperate  or  scrofulous,  and  some  combined 
both  evils;  so  that  it  must  be  admitted  there  were  other  causes 
besides  consanguinity  to  increase  the  probability  of  infirm 
ojffspring.  There  were  born  in  these  families  ninety-five 
children,  of  whom  forty -four  were  idiots;  twelve  others  were 
scrofulous  and  puny,  one  was  deaf  and  one  was  a  dwarf.  In 
some  of  the  families  all  the  children  were  either  idiotic  or 
very  scrofulous  and  puny.  In  one  family  of  eight  children 
five  were  idiotic.  'The  commissioners  of  idiocy  in  Connecti- 
cut found  in  one  hundred  and  sixty  cases  of  idiocy,  twenty 
w^hich  apparently  resulted  from  consanguineous  marriages. 
Of  these,  twelve  were  children  of  first  cousins,  three  of  sec- 
ond cousins,  one  of  third,  and  four  of  distant  relations.  Dr. 
Langdon  Down  found  that  out  of  seven  hundred  and  fifty- 
three  male  idiots  thirty-three  were  the  offspring  of  first 
cousins,  three  cases  of  second  cousins,  and  four  of  third 
cousins, — in  all  forty  cases  out  of  seven  hundred  and  fifty- 
three,  or  rather  more  than  five  per  cent.  Of  the  two  hundred 
and  ninety-five  females,  thirteen  were  the  children  of  first 
cousins,  three  of  second  cousins,  and  four  of  third  cousins, — 
in  all  twenty  among  two  hundred  and  ninety-five,  or  a  little 
less  than  seven  per  cent.  His  researches  show  that  in  Eng- 
land at  least  every  fourteenth  idiot  is  the  child  of  cousins. 
The  majority  of  cases  of  idiocy  appear  at  birth,  and  many 
such  may  be  traced  to  habits  or  tendencies  of  ancestors. 
Often  it  is  difficult  to  determine  in  what  generation  the  germs 
of  the  disease  were  planted.  Ludwig  Dahl,  of  Norway,  in 
his  work  on  "Insanity,"  shows,  by  means  of  a  genealogical 
tree,  how  an  apparently  healthy  couple  may  have  children, 
grandchildren  and  great-grandchildren  afiected  with  idiocy 
and  insanity.  In  revi(^ving  the  field  of  possible  causes  of 
idiocy,  I  am  greatly  impressed  by  the  apparent  influence  of 
consanguineous  marriages.  Dr.  S.  M.  Bemis,  of  New 
Orleans,  has  found,  through  his  examination  of  statistics, 
supplied  by  a  number  of  physicians,  that  among  two  thou- 


THE  HEAD,  FACE,  JAWS  AND  TEETH         213 

sand  seven  hundred  and  seventy-eight  children,  the  fruits  of 
intermarriage  of  first  cousins,  seven  hundred  and  ninety- 
three  were  normal;  one  hundred  and  seventeen  deaf  and 
dumb;  sixty-three  blind;  two  hundred  and  thirty-one  idiotic; 
twenty-four  insane;  forty-four  epileptic;  one  hundred  and 
eighty-nine  scrofulous;  fifty-three  deformed;  six  hundred 
and  thirty-seven  died  early. 

With  the  larger  percentage  of  neurotics  and  degenerates 
in  our  civilization,  the  chances  of  evil  from  consanguineous 
marriages  are  greatly  increased,  and,  inasmuch  as  prudential 
considerations  are  largely  neglected  in  such  matters,  the 
laws  of  some  of  the  states  of  the  Union  prohibiting  marriage 
between  first  cousins  are  not  unjustifiable. 


CHAPTER  XIX. 

INTEMPERANCE. 

There  is  a  wide  variance  of  opinion  among  medical  men 
regarding  the  probable  influence  of  intemperance  of  parents 
in  the  production  of  idiocy  and  alhed  conditions  in  their  off- 
spring. Dr.  Langdon  Down  is  emphatic  in  his  opinion  that 
drunkenness  at  the  time  of  conception  is  liable  to  produce 
serious  results  upon  the  brain  of  the  child.  Ludwig  Dahl 
believes  that  the  abuse  of  brandy  in  both  father  and  mother 
is  one  cause  of  the  large  number  of  idiots  in  Norway.  Demme 
reports  that  64  per  cent  of  the  idiots  received  during  seven 
years  in  the  Bern  asylum  had  drunken  parents — fathers 
mainly.  On  the  other  hand,  Dr.  C.  T.  Wilbur,  of  the  Illinois 
State  Asylum  for  Idiots,  states  that  in  three  hundred  and  sixty- 
five  idiotic  patients  eight  only  claim  drunken  parents.  Dr. 
Graham,  superintendent  at  Earlswood,  England,  also  states 
that  he  found  among  eight  hundred  inmates  of  that  institution 
but  six  cases  of  idiocy  which  could  be  attributed  to  intemper- 
ance of  parents.  Whether  or  not  drunkenness  is  responsible  for 
idiocy  we  cannot  decide,  but  we  know  positively  that  intem- 
perate habits  are  transmitted  from  generation  to  generation, 
each  series  of  progeny  in  the  line  of  descent  showing  a  lower 
grade  of  intellect.  As  further  illustration  I  cannot  do  better 
than  quote  Dr.  Shuttle  worth: 

' '  Considering  the  intimate  and  prolonged  dependence  of 
the  child  upon  the  mother  during  gestation  and  nursing, 
one  would  suppose  a  priori  that  maternal  rather  than 
paternal  drunkenness  would  count  most  in  the  production  of 
idiocy.  In  the  cases  which  I  have  tabulated,  drunken  fath- 
ers preponderate  in  a  majority  of  thirteen  to  four.  Possibly 
the  mental  anxiety  entailed  upon  the  wife  by  a  drunken  hus- 
band during  the  impressionable  period  of  pregnancy  may  in 
part  explain  the  discrepancy.  Whatever  the  direct  effect  of 
drink  upon  the  foetus  in  utero^  there  is  little  doubt  that  such 
nursing  as  a  child  is  likely  to  obtain  from  a  drunken  mother 

214 


THE    HEAD,    FACE,    JAWS    AND    TEETH  215 

will  intensify  any  predisposition  to  mental  defect.  The  bane- 
ful practice  of  giving  infants  alcoholic  drinks  seems  to  pre- 
vail to  a  great  extent  in  Sweden  and  Norway.  Such  prac- 
tice may  in  part  account  for  the  extensive  prevalence  of 
idiocy  and  juvenile  insanity  in  Scandinavia,  as  described  by 
Ludwig  Dahl." 

The  smallness  of  the  figures  reported  by  Drs.  Wilbur  and 
Graham  may,  perhaps,  be  reasonably  accounted  for  hy  the 
presumption  that  the  facts  were  not  fully  reported.  It  is 
usual  in  public  institutions  to  take  only  assigned  causes  in 
making  out  statistics,  and  it  is  very  commonly  the  case  that 
discreditable  causes  are  not  given  as  such  in  commitment 
papers,  etc.  Family  pride,  and  on  the  part  of  the  children, 
the  dislike  to  state  facts  discreditable  to  parents,  are  often  the 
causes  of  the  suppression  of  important  data.  The  reason  of 
the  preponderance  of  drunken  fathers  over  drunken  mothers 
is  easily  accounted  for,  when  we  take  into  consideration  the 
greater  tendency  to  intemperance  in  the  male  sex.  It  is 
doubtful  whether  there  could  be  found  in  this  country  as 
large  a  proportion  of  maternal  drunkeness  as  Dr.  Shuttle- 
worth  reports  in  Great  Britain. 

Idiocy  is  only  one,  and  that,  probably,  not  the  most  fre- 
quent evil  result  in  the  offspring  from  parental  intemperance. 
Insanity,  criminality  of  the  moral  insanity  type,  vagabond 
tendencies,  and,  perhaps,  more  than  any  other  one  thing, 
epilepsy,  may  be  traced  back  to  this  source.  Dr.  Hypolite 
Martin,  in  investigating  the  subject  of  epilepsy  in  children  in 
the  Salpitriere,  in  1877,  found  parental  intemperance  in  46 
per  cent  and  I  am  informed  by  one  who  has  had  fair  oppor- 
tunities of  observation,  that  a  very  large  proportion  of  the 
idiopathic  cases,  of  the  epileptic  inmates  of  the  insane 
asylums  have  this  antecedent.  The  obtainable  figures  are, 
moreover,  rather  under  the  truth,  in  all  probability,  owing 
to  the  diflBculty  already  mentioned  of  obtaining  correct 
reports  as  to  discreditable  facts.  The  gentleman  gives,  as 
instance,  that  he  has  known  parental  intemperance  denied 
absolutely  in  the  history,  while  a  drunken  parent  brought 
his  child  to  the  institution.     It  is  probable,  therefore,  that 


216 


ETIOLOGY  OF   OSSEOUS   DEFORMITIES   OF 


full  and  correct  data  would  give  a  very  high  proportion  of 
intemperate  antecedents  of  parents  in  idiocy,  insanity,  epi- 
lepsy, and  generally  in  other  neurotic  and  degenerative  con- 
ditions. If  we  take  into  account  also  the  poverty,  anxiety, 
disease,  and  all  the  unfavorable  conditions  due  to  intemper- 
ance, the  percentage  will  be  still  further  increased.  The 
habit  of  giving  alcoholic  drinks  to  infants,  alluded  to  by  Dr. 
Shuttle  worth,  is  not  at  all  uncommon  amongst  the  classes 
who  use  these  stimulants  freely,  and  with  this  should  be  men- 
tioned also  the  practice  of  giving  neurotic  stimulants,  such 
as  strong  tea  and  coffee,  to  very  young  children,  which  is  very 
common  in  the  poorer  classes  of  our  large  cities.  Tobacco, 
also,  is  frequently  given  to  children,  and  has  its  share  in  the 
production  of  degeneracy.  The  habit  of  cigarette  smoking 
by  young  boys,  so  much  deprecated  of  late,  seems  to  bear 
abundant  evil  fruit  in  the  production  of  insanity  and  other 
nervous  derangements,  and  prepares  the  way  for  future 
degeneration  in  the  offspring  of  its  habitues.  It  is  a  singular 
fact  that  nearly  all  of  the  inebriates  in  the  sanitariums  and 
as3'lums  are  habitual  tobacco  users  in  some  form  or  other. 
This  would  indicate  that  the  persons  so  using  it  had  acquired 
a  very  nervous  condition,  and  that  the  stimulant  was  uncon- 
sciously used  to  tone  up  a  nervous  system.  An  offspring  of 
such  a  parent  could  not  expect  to  inherit  a  strong,  healthy 
constitution. 

Deformities  of  the  jaws  among  this  class  were  found  to 
stand  second  to  those  of  the  prostitute  in  the  list  of  large 
percentages.  This  could  hardly  be  otherwise  when  we  con- 
sider the  fact  that  this  class,  like  the  prostitute,  is  a  marked 
neurotic  and  degenerate  one,  with  all  the  vices  combined. 

TABLE    OF    DEFORMITIES    OF   THE    JAWS     OF   THE    INEBRIATES.* 


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*  The  examination  of  inebriates  was  made  in  The  Keeley  Institute, Dwight, 
III.:  The  Inebriates' Home,  Ft.  Hamilton,  N.  S.;  Washington  Home,  Chicago, 
Washington  Home.  Boston,  and  Dr.  C'rother's  Institute,  Hartford,  Cona. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  217 

If  all  the  deformities  of  the  head  and  face  had  been 
included  there  would  have  been  fully  95  to  98  per  cent  of 
deformities  among  this  class  of  individuals.  Many  of  these 
unfortunates  were  geniuses  or  unusually  bright  people,  includ- 
ing doctors,  judges,  lawyers,  ministers,  railroad  officials  and 
business  men. 


CHAPTER  XX. 

MATERNAL  IMPRESSIONS. 

The  popular  beliefs  in  regard  to  the  effect  of  maternal 
impressions  on  the  offspring  are  not  shared  to  any  very  great 
extent  by  the  medical  profession — that  is,  in  their  extreme 
acceptation.  There  is,  of  course,  no  question  as  to  the  possi- 
ble influences  of  the  maternal  conditions  during  pregnancy, 
but  the  direct  action  of  maternal  impressions  is  exceed- 
ingly dubious.  If  the  popular  notion  in  the  regard  were 
based  on  fact,  it  would  be  extremely  unfortunate,  since  no 
pregnant  woman  can  be  assured  against  mental  and  emo- 
tional shocks  such  as  those  to  which  the  }3roduction  of  vari- 
ous monstrosities  is  attributed.  There  is,  however,  a  very 
great  possibility  that  cannot  be  disregarded  by  physicians, 
that  in  many  cases  serious  damage  may  be  done  to  the  unborn 
child  by  the  occurrence  of  such  accidents,  which  may  reveal 
itself  in  its  post-natal  development  under  some  one  or  more  of 
infinitely  variable  forms  of  physical  and  psychical  degeneracy. 
When  we  consider  that  the  mothers  in  these  cases  are  very 
likely  themselves  to  have  some  nervous  or  mental  instability, 
this  is  still  more  a  matter  for  consideration.  The  physical 
and  mental  conditions  of  either  parent  at  the  time  of  concep- 
tion may  have  their  influence,  though  this  is  not  often  readily 
determined.  Something  has  already  been  said  that  bears 
on  this  point  when  speaking  of  the  effects  of  intemperance  of 
parents — especially  paternal  intemperance — on  the  offspring. 

It  is  unquestionably  a  fact  that  a  fright  to  a  mother  dur- 
ing pregnancy  is  occasionally  a  cause  of  idiocy  in  children. 
Women  instinctively  shrink  from  anything  which  would  pro- 
duce a  shock  or  special  mental  impression  during  the  period 
of  gestation,  fearing  for  both  the  mental  and  physical  welfare 
of  the  child.  Strange  to  say,  the  same  maternal  instinct  pre- 
vails with  the  brute  creation. 

Dr.  G.  H.  Fisher  has  written  a  very  complete  history  of 
the    "Literature,   Classification,  and  Description  of  Human 

218 


THE    HEAD,    FACE,    JAWS    AND    TEETH  219 

and  Brute  Monstrosities,"  including  the  so-called  parasitic 
monster  known  as  "Fetus  in  Fwtu^''''  and  the  various  super 
numerary  formations  of  parts  and  organs  which  are  familiar 
to  medical  men.  Many  interesting  cases  are  given  by  this 
author,  including  deformities  of  the  upper  and  lower  extremi- 
ties and  internal  organs.  He  shows  that  the  lower  animals 
may  become  insane,  and  that  heredity  and  pre-natal  shocks 
have  much  to  do  in  producing  these  conditions. 

Innumerable  cases  of  pre-natal  shocks  producing  idiocy, 
where  the  parents  were  both  apparently  healthy,  are  on 
record.  In  one  case  the  news  of  the  loss  of  the  husband  at 
sea  had  the  effect  of  impairing  the  intellect  of  the  unborn 
child.  Again,  the  same  result  occurred  in  another  case  as  a 
result  of  fright  occasioned  by  a  team  of  horses  running  away 
with  the  mother  when  well  along  in  utero-gestation.  Baron 
Percy,  a  French  military  surgeon,  observed  that  out  of  ninety- 
two  children  whose  mothers  had  been  exposed  to  the  terrors 
of  a  tremendous  cannonade  at  the  siege  of  Landau,  in  1793, 
sixteen  died  at  the  instant  of  birth;  thirty -three  languished 
from  eight  to  ten  months,  and  then  died  before  the  age  of  five 
years;  and  two  were  born  with  numerous  fractures  of  the 
bones  of  the  limbs.'^^ 

Just  how  impressions  of  the  mother  affect  the  foetus  is 
difficult  to  describe,  but  that  they  do  produce  marked  effect 
is  illustrated  in  the  following  cases  :  A  man  and  wife,  living 
upon  a  farm,  had  twelve  children.  The  country  was  high, 
rolling  ground,  air  perfectly  pure,  and  one  of  the  healthiest 
districts  in  the  state.  The  death  rate  at  that  time  was  only 
about  three  per  1,000.  The  children,  six  boys  and  six 
girls,  were  born  just  about  two  years  apart.  The  surround- 
ings and  conditions  of  life,  as  far  as  I  am  able  to  ascertain, 
were  the  same  in  the  entire  twenty -four  j^ears;  no  taint  of 
any  kind  in  the  family  as  far  as  1  could  learn.  All  the  chil- 
dren grew  up  to  be  men  and  women.  The  fifth,  a  boy,  died 
at  the  age  of  twenty-two  years.  He  possessed  a  very  small, 
undeveloped  chest,  arrest  of  development  of  the  bones  of  the 
face  and  nose,  long  slender  nose,  total  collapse  of  the  outer 

*  Trans.  N.  Y.  State  Med.  Soc,  1865-68. 


220    .  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

walls,  and  chronic  nasal  catarrh,  which  he  possessed  from 
birth;  death  was  the  result  of  consumption  due  to  catarrh.  The 
seventh,  a  girl  of  eighteen,  died  of  consumption,  contracted 
by  contagion  while  nursing  a  sick  cousin  who  died  of  the  dis- 
ease. The  youngest,  a  man  now  twenty-four  years  of  age, 
has  head  and  face  excessively  developed  forward,  as  illustrated 
in  Fig.  88;  a  decidedly  V-shaped  upper  jaw  and  arrest  of 
dental  arch  of  the  lower  jaw;  chest  contracted;  only  one 
testicle  passed  into  the  scrotum,  a  condition  inherited  from 
his  father.  Has  taken  up  a  profession,  and  indoor  life  is  not 
conducive  to  health;  he  is  therefore  delicate.  The  man  is  as 
bright  if  not  brighter  than  any  of  his  brothers  or  sisters. 
Why  should  two  children,  the  fifth  and  last,  be  constructed 
so  difierently  when  all  the  conditions  are  the  same  ?  There  is 
only  one  answer — either  worry,  starvation,  or  physical 
debility.  The  author  could  select  many  cases  illustrating 
this  peculiar  uterine  development  and  education,  but  this  one 
is  sufficient  to  show  its  peculiarity. 


CHAPTER  XXI. 

CITY  VERSUS  COUNTKY  LIFE 

It  is  a  well-known  and  recognized  fact  that  the  people  of 
the  city  are  of  lower  stature,  lighter  limb  and  are  more  sus- 
ceptible to  the  ravages  of  disease.  That  mortality  is  greater 
and  longevity  less  in  the  city,  as  compared  with  the  country, 
is  too  well  understood  to  need  much  discussion.  *  The  mor- 
tality is  two  and  one-half  times  greater  in  the  city  than  in  the 
country,  f 

It  has  been  said  that  a  family  living  continuously  in  Lon- 
don, and  intermarrying  with  families  who  have  resided  in 
London  constantly,  would  die  out  in  three  generations. 
Again,  a  family  living  in  London  for  two  hundred  years  and 
marrying  among  people  not  less  old,  wiDuld  become  extinct 
within  the  two  hundred  years.  :|; 

If  all  the  people  of  the  world  lived  in  cities  the  human 
race  would  become  extinct  in  two  and  one-half  centuries;  §  in 
all  probability  the  mortality  would  be  greater  the  larger  the 
cities.  It  has  been  shown  that  women  attain  greater  longevity 
in  the  city  than  in  the  country.  In  the  country  the  life  of 
women  is  monotonous;  the  brain  is  used  very  little  and  very 
little  recreation  is  taken;  the  hours  of  work  are  very  long, 
from  early  morning  until  late  at  night;  thus  insufficient  sleep 
does  not  give  the  body -time  to  recuperate.  Longevity  of 
men  is  lessened  by  residence  in  the  city,  no  doubt  due  to 
closer  confinement  and  more  hazardous  occupations.  We  also 
find  that  dissipation  and  intemperance  are  increased. 

The  greater  mortality  of  cities  is  due  to  foul  air,  unsan- 
itary conditions  and  intemperance.  I|  Among  these  may  be 
included  irregular  hours,  want  of  exercise,  unhealthful  and 
more  hazardous  occupations,  undue  excitement  of  the  nervous 

*Mr.  Stoekton-Hough,  ''Relative  Influence  of  City  and  Country  Life." 
t  Professor  Donaldson;  Sussmilch;  Drs.  Jarvis,  Parr,  Berg,  Herz,  and  many 
others. 

t  Mr.  James  Cantile.    J.  Milner  Fothergill. 

^  "Relative  Influence  of  City  and  Country  Life." 

I  Dr.  Morgan. 


222  ETIOLOGY  or  OSSEOUS   DEFORMITIES  OF 

system,  less  pure  water,  unwholesome  food,  unhealthful  dress 
and  an  overcrowded  condition  of  the  people,  especially  in 
tenement-houses  and  flats.  We  must  not  forget  the  fact  that 
country  people  are  continually  thronging  to  the  city,  and  by 
intermarriage  with  city  people  infusing  new  blood  and  new 
life  into  them.  This  fact  no  doubt  adds  much  to  lessen  the 
mortality  of  the  city. 

That  the  quantity  of  oxygen  is  sensibly  diminished  in  the 
air  of  large  cities,  even  in  the  open  street,  cannot  be  denied.* 
The  large  number  of  people  congregated  in  a  small  area, 
together  with  the  artificial  means,  if  we  maj^  so  call  it,  of 
using  up  oxygen  by  means  of  increased  fires  and  light,  would 
naturally  reduce  the  oxygen  in  the  air  and  increase  the  car- 
bon dioxide;  add  to  this  the  fact  that  vegetation  is  utterly 
wanting,  which  is  the  chief  factor  in  using  up  the  superfluous 
carbon  dioxide  and  supplying  us  with  free  oxygen.  The 
amount  of  sunlight  is  also  diminished.  Now,  when  these  two 
conditions  exist,  we  would  naturally  expect  to  find  lessened 
physical  development.  "Light  is  the  very  life-blood  of  nature, 
without  which  everything  in  nature  would  perish  utterly."  f 
When  blood  passing  from  the  lungs,  where  it  does  not  obtain 
a  supply  of  oxygen,  carries  to  the  brain  and  other  tissues 
and  organs  carbon  dioxide,  the  consequence  of  an  arrest  in 
the  changes  necessary  to  life  and  growth  would  result.  X 
The  effects  of  carbon  dioxide  poisoning  are  far-reaching. 
Through  the  brain  it  affects  all  tissues  of  the  body.  Lack  of 
pure  air  and  of  bracing  air  creates  a  distaste  for  exercise; 
active  exercise,  but  exercise  not  carried  to  excess,  keeps  up 
the  equilibrium  between  waste  and  repair,  §  Another  cause 
of  the  lack  of  exercise  is  the  facility  with  which  different 
parts  of  the  city  may  be  easily  reached  by  means  of  street- 
cars, cabs,  omnibuses,  etc.  Then,  also,  we  find  that  people  in 
the  city  are  more  hampered  by  dress  than  those  in  the 
country,  which  is  a  cause  for  deficiency  of  exercise.  We  also 
find  in  the  city  a  lack  of  suitable  places  for  exercise.     Now, 

*  Professor  Wilson. 

t  Sir  David  Brewster. 

t  Dr.  Bell,  "Perils  of  School-room." 

I  Dr.  Darbishire,   "Recreation."  . 


THE     HEAD,    FACE,    JAWS   AND   TEETH  223 

since  deficiency  of  exercise  exists  among  city  people,  we 
would  naturally  expect  to  find  deficiency  of  physical  develop- 
ment, which  is  the  case.  The  city-born  criminal  is  found  to 
be  inferior,  physically,  to  the  country -bred."'  Biologically, 
man  is  a  fresh-air  animal  ;f  exercise  in  fresh  air  increases  the 
activity  of  all  organs  of  the  body.  Muscular  activity  demands 
activity  of  the  circulation  to  keep  up  the  equilibrium  of  waste 
and  repair.  Muscular  activity  creates  increased  activity  of 
all  the  eliminating  organs,  to  rid  the  body  of  the  products  of 
the  disintegration  of  molecular  activity  of  muscles.  The 
circulation  being  increased,  the  respiratory  system  is 
increased  to  meet  the  greater  demands  for  oxygen.  This 
brings  about  a  vigorous  action  of  all  the  organs  of  the  body, 
and,  being  a  physiological  process,  if  kept  within  physiolog- 
ical bounds  no  harm  but  good  can  result.  This  course  of 
living  was  carried  out  in  the  patriarchal  age.  There  was 
moderate  activity  of  all  the  organs  of  the  body;  there  was 
repose  to  the  nervous  system;  the  appetite  was  normal,  diges- 
tion was  healthy,  and  there  was  exemption  from  local  causes 
of  disease.  No  other  causes  of  death  occurred,  save  those 
arising  from  accidents  and  old  age.:|; 

The  converse  of  muscular  activity  producing  well-devel- 
oped physical  condition  must  be  true;  i.  ($.,  lack  of  exercise 
will  cause  lessened  physical  development.  §  Animals  which 
for  generations  back  have  taken  little  exercise  have  their 
lungs  of  smaller  size,  which  moderates  the  form  of  the  bony 
fabric  of  the  chest,  and  the  latter  afiects  the  form  of  the  body 
as  a  whole.  With  our  anciently-domesticated  birds,  where 
wings  have  been  little  used,  their  size  is  somewhat  dimin- 
ished, and  we  find  the  sternum,  coracoids  and  scapulae  modi- 
fied in  form,  ||  The  decrease  in  the  amount  of  exercise  must 
cause  a  decrease  in  the  appetite  or  create  an  abnormal  appe- 
tite. The  country-bred  person  therefore  eats  pastries,  meat- 
pies  and  hearty  food,  and  has  no  difficulty  in  digesting  them. 

*  Dr.  Beddoe. 

t  Dr.  Darbishire,  "Recreation." 

X  Dr.  Smith,  "  Limitations  and  Modifying  Conditions  of  Human  Lon- 
gevity." 

§  Herbert  Spencer,  "Physical  Education." 
II  Mr.  Darwin. 


2-24:  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

He  has  plenty  of  fresh  milk,  butter  and  vegetables;  the 
milk,  from  the  presence  of  the  phosphate  salts,  heightens 
stature.  "  The  city  person  cannot  eat  meat-pies  and  pastries 
at  all,  therefore  he  rejects  them.f  He  finds  that  he  can  eat 
meat;  as  a  consequence  he  partakes  largely  of  a  flesh  diet, 
but  his  exercise  is  hardly  sufficient  to  digest  this.  If  he  is 
not  strong  enough  it  passes  through  the  alimentary  canal 
undigested,  partly  decomposed,  causing  in  some  cases  only 
abdominal  tenderness;  in  other  cases  other  evils.:}:  If  the 
digestion  is  strong  enough  to  digest  this  food,  additional 
work  is  thrown  upon  the  liver  and  kidney.  Uric  acid  is  one 
of  the  products  of  the  oxidation  of  flesh  food.§  It  is  excreted 
by  the  kidneys,  and  sets  up  interstitial  nephritis.  Uric  acid 
is  also  a  cause  of  gout  and  lithsemia. 

Again,  the  city-bred  person  rejects  all  fats,  which  are 
necessary  to  healthy  tissue;  he  rejects  them  because  the 
greater  part  of  his  life  is  spent  in  an  overheated  room.  Peo- 
ple who  live  among  the  Esquimaux  soon  acquire  a  relish  for 
whale-blubber  and  all  the  fats  and  oil  they  can  obtain.  |  This 
lessened  use  of  fats,  and  diminished  oxygen  and  sunlight,  are 
the  great  causes  of  pulmonary  consumption,  which  claims 
twenty-five  per  cent  greater  mortality  in  the  city  than  in  the 
country.**  Deficiency  of  breast-milk  in  mothers  is  a  cause  of 
stunted  growth,  "'•  and  want  of  good  cow's  milk  is  also  a 
cause.  Early  and  copious  use  of  alcohol,  and  intemperance; 
want  of  opportunity  and  stimulus  for  the  development  of 
their  physical  powers  by  young  persons  in  town,  the  earlier 
occurrence  of  puberty,  :}::}:  and  greater  frequency  of  youthful 
profligacy*  are  among  the  etiological  factors  of  stunted 
growth.  The  crowding  of  people  in  tenements,  where 
breathing  of  effluvia  over  and  over  occurs,  also  the  crowding 
together  of  pauper  population  in  cellars  and  underground 
rooms,  must  act  as  fruitful  causes  of  deformities  and  disease. 

*Beddoe. 

t  J,  Milner  Fothergill. 

X  Dr.  C.  Chambers.  "  Dietetics." 

*5  Fothergill;  Dr.  Chambers. 

i  Darwin. 
**  Professor  Donaldson. 
ttQuetelet,  "On  Man." 


THE     HEAD,    FACE,    JAWS   AND   TEETH  235 

These  houses  are  often  erected  on  land  made  of  sweepin^^s  of 
streets,  where  the  streets  are  narrow  and  filthy.  The  sewer- 
age is  often  inadequate  to  the  demands,  and  the  contents  of 
cesspools  siu'charge  the  porous  earth.*  Wherever  such 
conditions  are  met  with,  sickness  must  prevail,  and  thus  all 
physiological  processes,  growth,  and  development  will  become 
perverted. 

In  the  city  the  constant  excitement  hastens  the  develop- 
ment of  the  nervous  system,  which  is  the  center  of  the  nerve- 
force  supplying  all  the  organs  of  the  body.  Unrhythmical, 
harsh,  and  jarring  sounds  cause  molecular  disturbance  of  the 
system.  Specialization  must  have  a  baneful  effect  upon  the 
body.  The  exclusive  concentration  of  mind  and  muscle  to 
one  mode  of  action  is  both  negatively  and  positively  per- 
nicious, and  more  so  when  accompanied  by  bad  air  in  over- 
heated and  ill- ventilated  apartments,  f  Close  confinement 
in  school-rooms,  together  with  competition,  which  must 
necessarily  follow  from  our  public  school  system,  must  work 
ravages  upon  the  system,  especially  the  nervous  system,  of 
the  children,  united  as  it  is  with  the  pernicious  conditions 
existing.  X  In  addition  to  the  school  duties,  the  city  child 
has  usually  to  pursue  the  study  of  music,  painting,  and  the 
like,  from  all  of  which  the  country  child  is  free.  All  these 
must  necessarily  produce  an  artificial  condition  of  life,  under 
which  condition  a  degenerated  physique  is  found,  and  more 
deaths  must  occur.  §  The  child  is  ill-equipped  to  meet  the 
demands  of  physical  life,  and  therefore  it  cannot  meet  the 
demands  made  upon  the  brain  and  nervous  system. 

Population  tends  to  concentrate  more  and  more  in  dense 
masses.  In  some  of  our  older  states  from  fifty  to  seventy- 
five  per  cent  of  the  whole  population  live  in  cities  number- 
ing eight  thousand  or  more.  Registration  reports  of  Massa- 
chusetts, which  have  now  been  published  for  forty-seven 
years,  show  that  in  thirty  years — from  1850  to  1880 — the 

*Dr.  Clendenin,  "General  Causes  of  Disease";  Dr.  Jas.  .Johnson:  Carl 
Pfeiffer. 

t  Dr.  Beard,  "American  Nervousness." 
X  Sir  John  Sinclair. 
§  Dr.  Price. 


226  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

average  age  of  all  persons  who  died  in  Suffolk,  in  which  Bos- 
ton is  included,  was  twenty-three  and  one-third  3^ears.  The 
corresponding  age  in  Barnstable  county,  also  on  the  sea- 
board, was  thirty-seven.  In  Franklin  county,  an  inland  rural 
county,  it  was  thirty-eight  and  one-half  years,  Avhile  in  the 
island  county  of  Nantucket  it  was  forty-six  and  fifteen  one- 
hundredth  years,  nearly  double  that  in  Suliolk  county,  thus 
showing  that  the  uniform  higher  death-rate  is  greater  in 
densely-populated  counties.  " 

In  the  town  of  Sharon,  Norfolk  county,  Mass.,  which  is 
the  highest  point  of  land  in  the  eastern  part  of  Massachusetts, 
and  has  a  population  of  about  thirteen  hundred,  the  average 
longevity  is  sixt3'-four  3'ears. 

*  President  C.  W.  Eliot,  '-Family  Stocks  in  Democracy." 


CHAPTER  XXII. 

CONSTITUTIONAL  LESIONS. 

The  results  of  constitutional  diseases  are  more  marked  in 
tlie  osseous  system  than  any  other  part  of  the  human  body. 
Debilitating  acute  diseases  (fevers,  the  exanthemata,  etc.)  in 
children  are  sonaetimes  followed  by  sudden  overgrowth  of 
bone,  which  is  quite  noticeable.  This  process  affecting  the 
osseous  system  may  account  for  certain  proportions  of  those 
cases  of  measles,  pneumonia  and  other  diseases  which  are 
followed  by  dental  irregularities  and  maxillary  deformities. 
In  some  cases,  however,  the  process  is  a  low  grade  of  inflam- 
mation, which  is  followed  by  atrophy  of  the  jaw  instead  of 
hypertrophy  or  hyperplasia.  The  special  predilection  of  these 
processes  for  the  superior  maxilla  is,  on  account  of  its  libera^ 
blood  and  lymphatic  supply,  and  the  contiguity  of  such  cavi- 
ties as  the  antrum  and  nasal  Jhssm,  which,  in  many  cases, 
contribute  their  quota  of  irritation. 

The  question  of  diathesis  enters  largely  into  the  etiology 
of  maxillary  and  dental  deformities.  The  physical  charac- 
teristics of  strumous  children  demonstrate  this  fact  quite 
forcibly.  The  description  of  this  diathesis  given  by  Fother- 
gill  is  decidedly  apt  in  this  connection:  "The  diathesis  has  an 
imperfectly  developed  osseous  S3^stem  as  one  of  its  character- 
istics. The  bones  are  small,  the  shafts  slender,  the  epiphyses 
enlarged;  the  hands  are  often  unshapely  from  this  osseous 
defect;  the  thorax  is  small;  the  forehead  is  high  and  promi- 
nent; the  jaw  is  small,  and  the  teeth  crowded  and  carious." 

Persons  of  a  nervous  diathesis  have  small  jaws.  Consti- 
tutional diseases,  such  as  the  exanthemata,  syphilis  and  phthi- 
sis may  affect  the  jaws  in  common  with  the  other  bony  struc- 
tures, and  as  the  teeth  do  not  vary  much  in  size  in  different 
subjects,  a  relatively  small  jaw  results  in  such  cases.  Dr. 
Florence  Hunt  informs  me  that  the  majority  of  the  Swedish 
and  Norwegian  patients  of  the  Cook  County  Insane  Asylum 
are  affected  with  scrofula  and  other  constitutional  diseases, 

227 


22  S  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

and  that  post-mortems  reveal  soft  and  undeveloped  epiphyses 
not  unlike  cartilages.  Writers  on  surgery  have  assigned  as 
some  of  the  causes  of  non-union  of  fractures  of  bones,  the 
so-called  scrofulous  condition,  the  existence  of  any  of  the 
exanthemata,  or  the  debility  arising  from  them,  and  syphilis.* 
The  arrest  of  development  of  the  entire  organism  following 
cerebro-spinal  meningitis  is  well  known  to  everyone. 

Pathologists  have  maintained  that  the  regenerative  pro- 
cess in  all  tissues  is  below  par  in  constitutional  diseases;  that 
is,  that  wounds  do  not  heal  so  readily  in  a  person  the  subject 
of  constitutional  disease.  The  development  of  tissue  from  an 
embryonal  type  to  mature  tissue  is  identical  with  the  regener- 
ative processf  in  the  healing  of  wounds,  or,  as  Senn:{;  calls  it, 
the  vegetative  process.  Therefore,  the  same  causes  that 
retard  the  one  process  must  retard  the  other.  Following  out 
the  theory  of  Metschnikoff  and  his  followers,  we  must  con- 
clude that  the  energy  of  the  organism  is  expended  in  repelling 
the  advances  and  barring  the  further  progress  of  the  micro- 
organisms that  are  the  causes  of  these  constitutional  diseases. 
In  consequence  of  this  continuous  warfare  between  the  cells 
and  microbes  the  tissue  cells,  that  are  regenerated,  do  not 
increase  the  size  of  the  organ  as  in  normal  development. 
That  these  constitutional  diseases  do  cause  an  arrest  of  devel- 
opment in  children  is  well  known  to  every  observant  parent. 
Sometimes  this  arrest  of  development  will  be  permanent  at 
the  time  of  the  disease,  but  more  often  the  growth  of  the 
child  is  stopped  for  one  or  more  years,  and  frequently  devel- 
opment will  not  go  on  until  the  child  is  taken  to  another 
climate.  The  effect  upon  the  jaws  and  teeth  is  very  marked, 
especially  is  this  the  case  in  the  upper  jaw.  When  arrest  of 
development  of  the  teeth  takes  place  pits  and  furrows  are 
found  upon  the  enamel.  Every  specialist  of  experience  is 
able  to  determine,  by  these  pits  and  furrows,  the  exact  year 
when  arrest  of  development  took  place.  The  well-known 
Hutchinson's  teeth,  familiar  to  every  physician  and  dentist, 
are  well-marked  illustrations  of  this  fact. 

"  Erichsen,  "Science  and  Art  of  Surgery."    Wyeth,  "Surgery." 

+  Hamilton,  "Pathology." 

X  Senn,  "Principles  of  Surgery." 


THE    HEAD,    FACE,    JAWS   AND   TEETH  229 

The  eruptive  fevers  in  children  have  a  tendency  to  leave 
the  system  in  a  neurotic  and  degenerative  condition.  We 
frequently  find  children,  w^ho,  before  their  illness  were 
apparently  healthy  and  well,  after  having  these  diseases  are 
sickly  and  ailing  for  years,  and  occasionally  they  never  wholly 
recover.  Such  conditions  affect  the  eyes  and  ears,  and  not 
infrequently  the  organs  of  speech.  The  eyes  remain  weak, 
and  occasionally  the  patient  becomes  nearly  or  quite  blind. 
The  hearing  is  frequently  permanently  impaired;  occasionally 
also  the  nerve  centers,  which  preside  over  the  development  of 
the  osseous  system,  and  there  is  a  general  arrest  of  develop- 
ment of  the  whole  body.  Such  persons  not  infrequently 
remain  sickly  through  life,  while  occasionally  they  recover 
their  health,  though  the  body  ceases  to  develop  its  normal 
size.     A  few  illustrations  will  not  be  out  of  place  here. 

A  young  girl,  now  fifteen  years  of  age,  born  of  apparently 
healthy  parents,  had  a  very  severe  attack  of  scarlet  fever  at 
the  age  of  seven  years.  Arrest  of  development  of  the  upper 
jaw,  and  a  V-shaped  arch  developed;  she  has  been  near- 
sighted ever  since  and  now  has  very  weak  eyes;  she  stopped 
growing  for  three  years;  she  was  taken  to  California  and 
Europe,  as  the  result  of  which  she  is  now  getting  her  full 
growth. 

A  boy  had  pneumonia  at  the  age  of  four.  He  is  now 
nine;  arrest  of  development  of  the  bones  of  the  face  is  very 
marked;  he  is  not  old  enough  yet  to  decide  what  effect  it 
will  have  upon  the  jaws  and  teeth;  he  has  stopped  growing, 
and  is  now  very  small  for  his  age. 

A  young  lady,  now  twenty-two  years  of  age,  had  scarlet 
fever  at  the  age  of  seven,  as  a  result  of  which  she  became 
deaf  and  dumb;  the  bones  of  the  face  and  jaws  are  unde- 
veloped, and  possesses  a  marked  V-shaped  arch ;  pits  and 
grooves  upon  her  teeth  denote  the  age  when  she  had  the 
disease;  she  has  developed  into  a  very  handsome,  full-grown 
woman. 

A  lady,  forty  years  of  age,  had  scarlet  fever  at  three 
years.  Her  eyes  became  inflamed,  and  she  lost  their  sight 
for  twenty-four   years,  when   they  gradually  grew  better, 


230  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

owing  to  change  of  climate;  she  can  now  see  fairly  well. 
However,  when  her  health  became  poor  her  eyes  still  troubled 
her;  she  is  fully  developed  in  size;  the  bones  of  the  face 
are  arrested  in  their  development;  the  jaws  and  dental  arch 
are  normal. 

Arrest  of  development  of  the  tissues  of  the  body  can 
take  place  at  any  period  as  a  result  of  the  constitutional 
diseases,  up  to  the  time  when  the  person  gets  his  full 
growth.  Arrest  of  development  of  the  jaws,  however,  the 
result  of  constitutional  diseases,  to  produce  dental  deform- 
ities, must  occur  prior  to  the  sixth  year.  This,  however, 
does  not  include  excessive  development  of  the  jaw-bones 
proper.  It  is  in  the  cases  like  those  just  mentioned  where 
arrest  of  development  is  apparently  not  inherited  in  the 
parent,  but  is  the  result  of  a  constitutional  disease  which 
afterward  becomes  a  fixed  type  and  is  handed  down  from  gen- 
eration to  generation.  In  this  way,  I  believe,  we  are  render- 
ing permanent  a  deformity  of  the  osseous  system  which  was 
originally  an  acquired  one. 


CHAPTER  XXIII. 

NEUROSES  OF  DEVELOPMENT  OF  THE  BONES  OF 
THE  HEAD  AND  FACE. 

Neuroses  of  development  of  the  bones  of  the  head  have 
been  fully  considered  in  the  chapter  on  crime. 

To  the  great  anatomist,  Camper,  belongs  the  credit  of 
studying  the  human  face  from  a  scientific  standpoint.  This 
great  anatomist  gave  his  name  to  the  famous  facial  angle 
which,  even  up  to  the  present  day,  serves  as  a  standard  by 
which  to  judge  the  rank  of  the  human  face  in  comparison 
with  the  lower  forms  of  animals.  In  one  of  his  works  he 
gives,  "physical  observation  on  the  difference  of  the  feature 
of  the  face  considered  in  profile,  as  the  heads  of  apes,  orang- 
outangs, of  negroes  and  other  peoples,  tracing  up  to  the 
antique  heads. "  "You  will  be  astonished,"  he  says,  "to  find 
among  my  first  plates  two  heads  of  apes,  then  one  of  a  negro, 
and  then  one  of  a  camel."  Since  Camper's  time  scientists, 
alienists  and  neurologists  have  been  able,  by  close  study  and 
observation  of  certain  peculiar  forms  and  shapes  of  the  face, 
to  group  typical  deformities  with  certain  forms  of  degener- 
acy. Thus,  as  early  as  1820,  Groham,  who  had  given  much 
attention  to  facial  expression  and  cranial  characteristics, 
anticipated  the  conclusion  of  modern  criminal  anthropolgists. 
He  wrote:  "  I  have  often  been  impressed  in  criminals,  and 
especially  in  those  of  defective  development,  by  the  prominent 
ears,  the  shape  of  the  cranium,  the  projecting  cheek-bones, 
the  larger  lower  jaw,  the  deeply  placed  eyes,  the  shifty,  ani- 
mal-like gaze."  Charles  Kingsley  made  the  remark  many 
years  ago:  "  I  have  generally  seen,  with  strong  animal  pas- 
sion, a  tendency  to  high  cheek-bones,  and  who  also  possess 
dark  complexion.  These  generally  are  confined  to  women." 
Mosso  found  prominent  zygomae  or  cheek-bones  in  thirty  per 
cent  of  sexual  offenders  against  twenty-two  per  cent  normal 
persons.  Lombroso  says  born  criminals  have  projecting 
ears,  thick  hair,  thin  beard,   projecting  frontal  eminences, 

23] 


232  ETIOLOGY   OF  OSSEOUS  DEFORMITIES  OF 

enormous  jaws,  a  square  and  projecting  chin,  large  cheek- 
bones and  frequent  gesticuhition.  It  is,  in  short,  a  type 
resembling  the  Mongolian  or  sometimes  the  Negroid.  Like 
Lombroso\s  Negroid  or  Mongolian  types,  among  criminals, 
so  Langdon  Down  has  found  the  same  among  idiots,  with  the 
exception  of  protruding  chin;  Langdon  Down  has  in  almost 
every  case  found  retreating  chins.  Tarnowsky,  in  her  work, 
says:  "The  anomalies  of  the  face  are  frequently  shown  in 
asymmetry,  prognathism  and  evident  disproportion  of  vari- 
ous parts  of  the  face.  There  is  a  profound  excavation  at  the 
root  of  the  nose.'' 


Fig.  54. 

While  I  ao^ree  with  these  authors  that  prominent  cheek- 
bones and  protruding  and  receding  chins  are  apparent 
among  the  degenerate  classes,  yet  my  own  experience 
teaches  me  that  other  conditions  exist  which  these  authors 
have  overlooked,  which,  however,  have  a  great  bearing  upon 
the  degenerate  classes.  As  in  the  classification  of  the 
deformities  of  the  jaws  and  teeth,  I  have  not  been  able  to  find 
any  two  just  alike;  but  it  will  not  do  to  say  that  certain  forms 
denote  idiocy,  others  criminality,  still  others  prostitution  and 
epilepsy.  We  shall  not  only  find  these  abnormalities  among 
all  of  the  degenerate  classes,  but  among  our  professions,  busi- 
ness men,  in  school-rooms  and  even  our  homes.  (Most  of  the 
cases  here  enumerated  are  my  private  patients,  and  while  I 
am  not  at  liberty  to  describe  each  case  as  I  would  like,  yet 


THE     HEAD,    FACE,    JAWS    AND   TEETH 


233 


enough  can  be  said  of  each  case  to  give  a  clear  description. 
It  was  with  considerable  difficulty  I  obtained  their  consent  to 
allow  me  their  pictures  for  this  work.  In  each  case  the  con- 
sent was  only  obtained  by  a  promise  that  names  should  not 
be  mentioned  and  that  the  object  was  purely  for  science.) 
First,  what  causes  the  seeming  protrusion  of  the  zygoma3  or 
cheek-bones,  and  the  lower  jaw?  Let  us  examine  the  faces  of 
the  following  persons,  and  Ave  shall  not  only  find  protrusion, 
but  also  arrest  of  development  of  these  bones.  Again,  a 
prominence  of  one  side  and  an  arrest  of  the  other. 


Fig.  55. 

The  following  deformities  of  the  face  are  due  to  arrest  of 
development.  These  cases  are  classified  according  to  their 
deformity,  making  it  easy  for  the  reader  to  understand  them. 
In  the  following  case  I  could  not  obtain  the  consent  of  the 
patient  to  use  her  picture,  but  the  one  here  shown  is  taken 
from  Tarnowsky,  and  is  a  correct  outline  of  the  face  of  my 
patient,  from  whom  I  obtained  the  following  history: 

Case  I,  Fig.  54.— Is  a  school-teacher,  thirty-two  years  of 
age,  of  a  very  nervous  temperament,  bright  and  well  edu- 
cated.    Father  and  mother  living;  father  a  periodical  drunk- 


234 


ETIOLOGY  OF   OSSEOUS  DEFORMITIES    OF 


ard;  grandmother  died  of  consumption.  One  of  her  cousins 
committed  suicide,  and  another  became  insane.  A  sister  of 
cousin  hanged  herself.  Grandmother,  on  mother's  side, 
became  insane,  and  a  grand-aunt  committed  suicide.  She 
was  born  in  the  East,  but  came  west  on  account  of  a  ten- 
dency to  consumption.  The  forehead  is  very  prominent, 
with  a  marked  depression  at  the  bridge  of  the  nose.  The 
nose  is  undeveloped,  and  has  the  appearance  of  falling  into 
the  face.  Hypertrophy  of  the  mucous  membrane  and  bones 
of  the  nose  require  her  to   breathe  through  the  mouth.     The 


Fig.  56. 

chest  is  undeveloped,  and  she  is  quite  round-shouldered.  The 
jaws  and  chin  are  fairly  well  developed.  The  alveolar  pro- 
cess, although  small  for  the  body,  has  normal  dental  arches. 
Width  outside  first  permanent  molar,  2;  outside  second 
bicuspid,  1.90;  width  of  vault,  1.60;  height  of  vault  .62. 
Third  molar  not  present,  and  teeth  small,  hence  the  reason 
for  no  deformity. 

Case  II,  Fig.  55. — Is  that  of  a  young  man  eighteen  years 
of  age.  His  mother  died  of  epilepsy  when  he  was  two  years 
old.     Father  died  of  locomotor  ataxia  about  six  years  ago. 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


235 


He,  therefore,  has  inherited  a  marked  neurotic  tcndenijy. 
The  lower  jaw  seems  to  be  quite  prognathous,  while  the  face, 
from  the  upper  border  of  the  lower  teeth  to  the  superciliary 
ridge,  is  markedly  concave.  The  superior  maxillary  bones, 
as  well  as  the  zygomse,  are  arrested  in  their  development. 
The  eyes  have  a  sleepy  look  and  are  quite  deeply  set  in  the 
head;  forehead  narrow  and  quite  prominent.  This  seems  to 
be  a  case  of  atavism.  There  is  a  total  collapse  of  the  walls 
of  the  nose,  difficulty  in  breathing,  hypertrophy  of  the  tur- 


Pig.  57. 

binated  bones  and  mucous  membrane,  adenoid  growth,  and 
mouth-breathing.  In  this  case,  we  cannot  say  that  the  lower 
jaw  is  excessively  developed,  because  the  teeth,  which  are 
not  large,  just  fill  the  space,  while  the  incisors  do  not  pro- 
trude, and  the  third  molars  are  in  place.  The  upper  jaw, 
however,  is  greatly  arrested  in  its  development.  The  third 
molars  are  not  present.  They  could  not  erupt  if  they  were 
there  for  want  of  space.  (My  experience  has  been  that  the 
third  molar  is  nearly  always  missing  in  neurotics  and  degen- 
erates.) The  left  first  bicuspid  has  been  extracted,  thus 
allowing  spaces  to  occur  between  the  incisors.     In  order  that 


236 


ETIOLOGY   OF  OSSEOUS  DEFORMITIES   OF 


the  teeth  may  all  come  into  position,  the  anterior  alveolar 
process  has  been  pushed  forward  .60  of  an  inch.  If  the 
bones  of  the  face  had  developed,  the  lower  jaw  would  have 
appeared  to  a  better  advantage.  This  case  shows  an  arrest 
of  development  of  the  superior  maxillae,  zygomae  and  nasal 
bones,  with  a  normal  lower  jaw.  A  marked  ridge  extends 
the  entire  length  of  the  vault  at  the  suture.  The  distance 
outside  of  first  molar  is  2;  outside  second  bicuspid,  1.75;  width 
of   vault  between  second  bicuspid,   1;  height  of  vault,   .62, 


Fig.  58. 

The  chest  walls  are  very  contracted,  the  shoulders  consid- 
erably stooped,  and  chest  expansion  very  slight.  Owing 
to  the  death  of  his  parents  it  is  impossible  to  state  whether 
this  is  a  direct  inheritance  or  an  arrest  of  development  in  the 
individual. 

Case  III,  Fig  56. — A  young  man,  twenty  years  of  age,  a 
marked  neurotic;  bookkeeper;  is  above  the  average  in  intel- 
lect; has  a  bright,  piercing  eye.  The  appearance  of  the  face 
and  jaws  are  about  the  same  as  Fig.  55,  with  this  exception, 
that  the  zygomse  are  a  little  more  developed.  Width  out- 
side first  permanent  molars,  2;  outside  second  bicuspid,  1.172; 


THE  HEAD,  PACE,  JAWS  AND  TEETH 


237 


between  second  bicuspid,  1.02;  height  of  vault,  .59.  There 
is  a  total  collapse  of  the  nasal  openings,  causing  him  to  breathe 
through  the  mouth  since  he  was  four  years  of  age;  the  two 
sides  of  the  left  nostril  approximate,  v»^hile  the  turbinated 
bones  upon  the  right  side,  owing  to  hypertrophy,  fill  the 
space.  A  thickening  of  the  mucous  membrane  throughout 
the  anterior  and  posterior  nares  is  also  observed.  This  picture 
was  taken  two  years  after  the  contour  of  the  teeth  had  been 
restored;  therefore,  the  upper  lip  is  more  pronounced  than  in 


Fig.  59. 


Fig.  55.  There  is,  however,  a  marked  concavity  of  the  face 
between  the  zygomse  and  the  upper  jaw;  the  upper  lip  was 
depressed,  as  in  Fig.  55,  before  the  operation.  The  chest  is 
very  contracted,  with  very  little  or  no  expansion  on  inhala- 
tion. He  has  an  anaemic  look,  due  to '.close  confinement.  The 
father  has  well-formed  jaws,  while  his  mother  possesses  a 
marked  arrest  of  development  of  the  upper  jaw,  showing  that 
he  has  inherited  this  condition  from  the  mother.  His  father 
is  an  honored  business  man. 

Case  IV,  Fig.  57. — Stenographer;  married;  of  excellent 
habits  and  good  principles;  steady  and  a  hard  worker.   When 


238  ETIOLOGY  OF  OSSEOUS    DEFORMITIES  OF 

a  small  child  his  relatives  claim  that  he  was  a  chubby,  fat 
boy.  His  father  and  uncle  possess  this  arrest  of  develop- 
ment. This  gentleman,  has  two  sisters  and  a  brother;  one  of 
the  sisters  has  the  deformity,  and  a  brother  slightly.  Upon 
examination  I  find  cheek-bones  prominent,  arrest  of  develop- 
ment of  the  superior  maxillary  bones,  a  well-formed  and 
regular  alveolar  process  and  dental  arch,  fine  teeth,  and  full 
normal  lower  jaw.  Width  outside  first  permanent  molar, 
2.25;  outside  second  bicuspid,  1.90;  width  of  vault,  1.20;  height 
of  vault,  .52.  With  such  a  history  no  one  could  dispute  that 
this  deformity  was  a  clear  case  of  direct  heredity.     The  chest 


Fig.    60. 

is  a  little  broader  than  the  other  two,  but  there  is  the  same 
Aveakness  of  voice  that  is  observed  in  the  other  two. 

Case  V,  Fig.  58. — This  man  is  a  graduate  of  medicine  and 
dentistry;  above  the  average  in  intellect.  Father,  mother, 
brother  and  sisters  all  living;  no  family  history.  He  was 
born  a  marked  neurotic;  a  fair  dentist,  but  liked  medicine 
better,  and  would  have  made  a  good  practitioner;  was  a  good 
musician;  could  play  several  instruments,  but  preferred  the 
cornet.  Arrest  of  development  of  the  upper  jaw  occurred  at 
or  about  the  sixth  year.  As  the  teeth  were  crowded,  with  con- 
siderable protrusion  of  the  anterior  teeth  and  alveolar  process, 
there  w^as  a  pronounced  semi-saddle-shaped  jaw.  Was  strictly 
temperate.     Died  at  the  age  of  twenty-six  years  of  general 


THE     HEAD,    FACE,    JAWS    A?sD    TEETH 


239 


paralysis.     Width  outside  first  molar,   2.0:>;  outside  second 
bicuspid,  1.90;  inside,  1.60;  lieio^ht  of  vault,  .75. 

Case  VI,  Fis^.  r)9. — Aojed  thirty -six  years;  married.  Born 
in  England  of  English  parents.  Father  sailor.  Father  died  of 
inflammation  of  bowels;  mother,  rheumatism  of  the  heart. 
No  history;  came  to  America  fifteen  years  ago.  Is  in  the 
harness  business;  a  man  of  excellent  habits.  He  is  a 
neurotic.  The  bones  of  the  face  are  arrested  in  their  develop- 
ment.    The  line  drawn  from  the  bridge  of  the  nose  to  a  point 


Fig.  61. 


opposite  second  molar  produces  a  marked  depression.  There 
is  a  marked  arrest  of  the  lower  jaw.  The  anterior  surface  of 
the  lower  centrals  occlude  at  the  first  bicuspid;  this  gives 
the  appearance  of  no  chin.  All  the  teeth  are  present  in  the 
upper  jaw,  the  width  of  which  is  1.75  outside  first  permanent 
molar;  it  is  also  a  saddle-shaped  arch.  In  order  that  the 
jaws  may  accommodate  all  the  teeth,  they  have  pushed  the 
alveolar  process  and  jaw-bones  forward.  This  man  has  been 
a"" mouth-breather  all  his  life;  the  mouth,  therefore,  has 
always  been  open;  the  result  is  that  the  teeth  and  alveolar 
process  have  grown  downward.     Although  the  lips  are  long 


240 


ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 


enough,  he  cannot  close  them,  owing  to  the  excessive  develop- 
ment of  the  teeth  and  alveolar  process.  The  alveolar  process 
and  teeth  of  the  lower  jaw  are  normal  in  development.  The 
height  of  vault  is  .82  (this  is  an  unusual  high  vault).  The 
alveolar  process  is  large  and  thin.  This  nicely  illustrates 
how  high  vaults  are  produced.  The  cheek-bones  are  also 
arrested,  but  not  to  the  extent  of  some.  The  eyes  are  deeply 
set;  the  supercilliary  ridges  very  prominent.  The  nose  is  very 
long  and  thin;  the  sides  of  the  nose  approximate,  and  there 


PR 

III!   -a  '  fc^ 

...^"^ 

P^„ 

^l^m 

|^g|, 

> 

V 

^ 

>^^,  l^-- 
W^^' 

A.  -<'■-.«   ■■'      /  '■ 

Fig.  62. 

is  a  marked  thickening  of  the  raucous  membrane;  nose- 
breathing  is  impossible;  the  chest  is  contracted,  and  the 
mouth  is  continually  open.  The  head  is  microcephalic;  the 
forehead  low;  the  posterior  part  of  the  head  is  very  prominent; 
ears  large. 

Case  VII,  Fig.  60. — Twenty-four  years  of  age.  Her  father 
is  now suflfering from  paralysis.  No  history;  a  neurotic;  very 
tine  musician  and  artist;  brilliant  conversationalist.  Jaw- 
bones proper  are  well  developed.  The  rami  are  excessively 
developed,  but  the  teeth  and  alveolar  process  are  undevel- 
oped.    There  is  very  little  enamel  upon  the  teeth,  and  what 


THE    HEAD,    FACE,    JAWS    AMD   TKKTH 


241 


remains  can  be  scraped  off  like  horn.  The  crowns  of  the 
teeth  are  worn  away  one-half  their  length.  Width  of  jaw 
outside  first  molar,  2.25;  outside  second  bicuspid,  2;  width 
of  vault,  1.50;  height  of  vault,  .50.  She  is  unable  to  bring 
the  teeth  together,  and  therefore  cannot  masticate  her  food. 
To  compensate  for  this  she  does  her  chewing  with  her  tongue 
and  the  roof  of  her  mouth,  on  account  of  which  her  tongue 
has  become  hypertrophied  to  such  an  extent  that  the  jaw  has 
been  widened  by  the  lateral  pressure  upon  the  teeth.  With 
an  effort  she  can  bring  her  jaws  together,  which  makes  her 


Fig.  63. 

pout  and  the  chin  protrude,  making  her  resemble  an  old 
woman.  In  order  to  meet  this  deficiency  crowns  were  placed 
upon  all  her  teeth,  which  has  the  effect  of  bringing  her  jaws 
at  rest  in  the  proper  position. 

Case  VIII,  Fig.  61. — This  little  fellow  is  eight  years  of 
age.  His  father  and  mother  are  Scotch  and  are  cousins.  He 
has,  what  is  generally  understood  to  be,  an  arrested  hydroceph- 
alic head;  it  is,  however,  a  macrocephalic  head.  He  is  about 
the  average  in  regard  to  intellect.  The  first  permanent 
molars  have  erupted,  and  the  central  incisors  are  just  coming 


242 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


through.  It  is  early  vet  to  decide  just  what  deformity  will 
be  produced,  because  the  permanent  teeth  are  not  far  enough 
advanced.  A  saddle  or  Y-shaped  arch  is  sure  to  follow, 
because  there  is  not  room  for  the  cuspids  and  bicuspids  to 
erupt.  Arrest  of  development  of  the  lower  jaw  is  quite 
noticeable  at  this  early  age.  There  is  considerable  hyper- 
trophy of  the  superior  alveolar  process  now.  Width  outside 
lirst  molar,  2;  height  of  vault,  ,50.  This  boy  will  either 
become  a  genius  or  a  degenerate.     It  is  my  experience  where 


Fig.  64. 

he  anterior  lobes  of  the  brain  are  so  prominent  and  over- 
' developed,  that  arrest  of  the  upper  jaw  results. 

Case  IX,  Fig.  62. — This  girl  is  fourteen  years  of  age. 
Father  and  mother  living.  She  is  a  marked  neurotic.  The 
upper  jaw  and  face  were  very  much  undeveloped.  The  dental 
arch  was  V-shaped,  and  the  teeth  very  irregular.  This  pict- 
ure was  taken  after  the  teeth  were  regulated.  The  upper 
dental  arch  was  spread  .62.  The  face,  therefore,  is  fuller  in 
every  direction,  and  appears  at  a  better  advantage  than  it 
would  otherwise.  There  is  excessive  development  of  the 
anterior  lobes  of  the  brain,  with  corresponding  fullness  of  the 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


243 


anterior  part  of  the  head;  she  is  very  bright  and  a  fine  reader. 
The  jaw  became  arrested  at  the  sixth  year.  Width  outside 
first  permanent  molar,  1.75;  outside  second  bicuspid,  1.50; 
width  of  vault,  .84;  height  of  vault,  50.  Before  treatment 
the  face  was  very  thin  and  contracted  at  the  alse  of  the  nose, 
not  unlike  Figs.  55,  56,  57.  Is  a  mouth-breather;  marked 
thickening  of  the  mucous  membrane,  and  hypertrophy  of  the 
turbinated  bones.  While  the  chest  is  very  much  contracted, 
it  is  now  filling  out;  she  has  a  husky  voice  and  a  very  old 


Pig.  65. 

face.     This  case  shows  how  much  a  face  can  be  improved  by 
treatment. 

Case  X,  Fig.  63. — Seven  years  of  age.  Father  and 
mother  living.  No  history;  both  have  well-developed  jaws. 
The  anterior  lobes  of  the  brain  are  excessively  developed,  and 
the  anterior  part  of  the  head  is  quite  high  and  prominent. 
This  boy  has  always  been  a  mouth-breather,  and  has  been 
sick  most  of  his  life;  he  had  so  little  vitality  that  it  was  with 
difficulty  that  he  has  been  raised  to  this  period  of  life;  he  is 
now  very  delicate.  Deflection  of  the  septum,  hj^pertrophy 
of  the  mucous  membrane,  and  turbinated  bones.    The  mouth 


244 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


has  been  kept  open  to  such  an  extent  that  occlusion  has  not 
taken  place.  The  rami  are  short;  the  result  of  this  is, 
nature  has  caused  an  excessive  development  of  the  anterior 
alveolar  process.  Width  outside  first  molar,  2;  outside 
second  temporar}^  molar,  1.75;  width  of  vault,  1;  height  of 
vault,  .86.  I  expect  that  the  face  will  remain  undeveloped 
from  this  period. 

Case  XI,  Figs.  64  and  65. — Aged  thirteen  years.  Father 
and  mother  living;  father  a  paranoiac;  has  an  excessively 
developed  forehead  and  well-developed  jaw.      The  boy  is  a 


^# 

Altaw«-' 

^BS  ^'^ 

W"^ 

^K'-     '^  ~ 

^M 

f^ 

mttSm 

•«K»  , 

^^^^^Hi'  /'^JSki^  :Jiit 

"^ 

Fig.  (JG. 


marked  degenerate,  almost  bordering  on  imbecility.  The 
anterior  cerebral  lobes  are  well  developed,  and  the  forehead, 
like  the  father's,  is  also  well  developed.  The  face  looks  like 
that  of  a  man  thirty-five  or  forty  years  of  age.  The  whole 
body  is  arrested  in  its  development.  His  legs  are  short  and 
he  walks  like  a  man  of  seventy.  The  joints  are  large,  while 
the  bones  are  very  small,  show^ing  impoverished  blood. 
There  is  a  marked  arrest  of  development  between  the  super- 
cilliary  ridges  and  the  zygomse,  and  also  the  lower  jaw; 
this  gives  an  apparent  protrusion  to  the  nose  and  upper  jaw. 


THE     HEAD,    FACE,    JAWS    AND   TEETH 


245 


The  eyes  and  their  sockets  are  also  arrested,  and  he  is  obliged 
to  wear  glasses  on  account  of  astigmatism.  The  bones  of  the 
nose  are  well  developed  and  there  is  plenty  of  breathing 
space.  He  has  a  growth  of  fine,  white  hair  all  over  his  face. 
The  ears  are  undeveloped,  consequently  the  hearing  is 
aflected.  Width  outside  first  permanent  molar,  1.84;  out- 
sideL'second  bicuspid,  1.75;  width  of  vault  between  second 
bicuspids,  .84;  height  of  vault,  .50.  While  the  boy  was 
under  treatment,  I  prescribed  beef,  wine  and  iron,  which  he 
needed,  owing  to  the  impoverished  condition  of  the  blood. 


Fig.  67. 

His  father  would  not  let  him  take  it  because  it  contained  wine. 
I  then  put  him  on  gentian.  When  the  treatment  was  about 
half  finished,  I  sent  in  a  bill.  The  father  wrote  in  reply  that 
he  was  out  of  money,  and  that  I  must  trust  in  the  Lord.  I 
have  been  doing  so  for  the  past  three  years. 

Case  XII,  Fig.  66. — This  young  lady,  sixteen  years  of 
age,  came  to  me  to  have  a  deformity  of  the  mouth  corrected, 
four  years  ago.  Her  mother  is  a  neurotic;  her  father, 
although  a  large,  fleshy  man,  has  small  jaws.  Marked  arrest 
of  development  of  the  bones  of  the  face  has  taken  place. 
She  possesses  a  very  thin  nose,  deflection  to  the  left  of  the 


246 


ETIOL(^GY   OF   OSSEOUS   DEFORMITIES   OF 


septum;  enlarged  right  inferior  turbinated  bones,  andhypertro- 
phied  mucous  membrane.  Siie  is  a  mouth-breather  like  Fig. 
63 — the  mouth  being  kept  open.  The  anterior  alveolar  pro- 
cess has  developed  downward,  causing  the  teeth  to  protrude. 
Width  outside  of  first  molar,  1.95;  outside  second  bicuspid, 
1.65;  width  of  vault,  1;  height  of  vault.  47. 

Case  XIII,  Fig.  67. — Excessive  development  of  the  bones 
of  the  face.  This  lady,  thirty-two  years  of  age,  married,  has 
one  child.     Father  and  mother  living  and  in  perfect  health. 


Fig.  68. 

She  is  healthy  in  every  respect  and  above  the  average  in 
intellect.  Bones  of  the  face  normal,  except  zygomae,  which 
are  excessively  developed. 

Case  XIV,  Fig.  68. — This  young  man  was  born  and  raised 
in  Boston.  He  possesses  a  weak  physical  make-up;  has 
very  contracted  chest  and  stoops.  Marked  arrest  of  bones  of 
the  face.  Long,  slender  nose,  the  outer  Avails  coming  in 
contact  with  the  inner,  and  is  therefore  a  mouth-breather. 
There  is  a  slightly  excessive  development  of  the  lower  jaw. 
He  was    supposed  to  be  in  consumption,    and  was  ordered 


THE     HEAD,    FACE,    JAWS    AND    TEETH 


247 


west.  The  chanoje  of  climate  and  out-door  exercise  have  com- 
pletely restored  him  to  health. 

Case  XV,  Fig.  69. — This  gentleman,  a  medical  student, 
possesses  about  the  same  history  as  Case  XIV.  He,  however, 
has  a  more  marked  deformity.  There  is  a  great  arrest  of 
development  of  the  bones  of  the  face,  and  a  more  marked 
protrusion  of  the  chin;  this,  however,  does  not  show,  owing 
to  the  beard. 

In  comparison  of  these  cases  ihere  is  very  little  difference 


't 


Fig.  69. 

in  width  of  the  upper  jaw  in  the  first  live  cases.  Three  are 
2,  one  2.03  and  one  2.25.  Fig.  54  shows  arrest  of  develop- 
ment at  the  bridge  of  the  nose.  Fig.  55  shows  arrest  of 
development  of  the  bones  of  the  face  extending  from  the 
supra-orbital  ridge,  including  the  eyes,  zygomte  and  superior 
maxilla,  presenting  a  concavity  of  the  face  as  far  down  as 
the  superior  border  of  the  inferior  teeth.  Fig.  56  is  precisely 
like  Fig.  55,  with  the  exception  that  the  zygoma  are  still  more 
developed.  Fig.  57  is  exactly  like  the  last  two,  with  the 
exception  that  the  zygomse  are  still  further  developed.  In 
Fig.  58  the  features  are  still  more  normal,  but  arrest  of 
development  is  noticed  at  the  alee  of  the  nose.  Fig.  59  not  only 


248  ETIOLOGY    OF  OSSEOUS    DEFORMITIES  OF 

shows  arrest  of  development  of  the  bones  of  the  face,  but  also 
marked  arrest  of  the  inferior  maxilla.  The  apparent  prog- 
nathism is  the  same  in  all  except  Fig.  59,  This  is  not  exces- 
sive development  of  the  lower  jaw,  but  a  normal  develop- 
ment. The  lower  jaw  develops  independently  of  the  bones  of 
the  head,  and,  owing  to  its  mobility,  usually  develops  nor- 
mally. The  apparent  prognathism  is  due  to  arrest  of  the 
upper  jaw. 

In  a  large  proportion  of  cases,  however,  the  face  is  nor- 
mal, and  the  undeveloped  lower  jaw  is  present.  Again,  the 
bones  of  the  face  are  normall}^  developed  upon  one  side  and 
arrested  upon  the  other.  In  these  cases  all  the  conditions 
presented  in  the  chapter  on  the  development  of  the  bones  of 
the  face  are  readily  seen.  They  indicate  the  period  at  which 
the  part  of  the  brain  which  presides  over  the  function  of 
development  of  the  osseous  system  ceases  to  operate,  leaving 
the  bones  in  an  undeveloped  state. 

Comparing  these  faces,  and  their  deformities,  with  those 
of  the  degenerate  classes  the  deformities  of  one  do  not  differ 
from  the  other.  The  make-up  of  the  contour  of  the  head, 
face,  jaws  and  ears  of  Prendergast,  and  other  degenerates, 
differ  from  othej's  only  under  dental  observation.  The  ques- 
tion naturally  arises,  at  this  point,  as  to  how  frequently 
stigmata  occur  with  people  in  the  common  walks  of  life. 
Repeated  examinations  in  street  and  steam  cars,  medical  and 
dental  colleges,  halls  and  practice  in  and  about  Chicago  have 
given  the  following  results:  In  practice  68  per  cent,  in  halls, 
cars,  etc.,  from  45  to  65  per  cent;  in  a  billiard  hall,  out  of  128 
persons  either  i)laying  or  looking  on,  72  or  87  per  cent  of 
deformities  of  the  face  and  jaws.  In  medical  and  dental  col- 
leges, where  students  come  from  the  country  and  different 
parts  of  the  United  States,  the  percentage  will  fall  as  low  as 
45  per  cent,  while  in  the  congregation  of  city  people  the  per 
cent  of  deformities  will  range  from  55  to  65.  It  would  not 
be  fair  to  take  the  percentage  of  my  patients  into  considera- 
tion, because  my  practice  is  made  up  largely  of  the  treatment 
of  irregularities  of  the  teeth.  In  analyzing  the  large  percent- 
age, found  in  dental  examinations,  the  fact  should  be  remem- 


THE     HEAD,    FACE,    JAWS    A:ND   TEETH  249 

bered  that  irregularities  of  the  jaws  and  teeth  come  under 
observation  in  large  numbers  for  special  treatment.  It  would, 
however,  be  safe  to  say  that  from  55  to  60  per  cent  possessed 
these  deformities.  Taking  the  defective  classes  as  a  whole, 
as  found  in  our  asylums,  the  percentage  of  deformities 
between  them  and  society  at  large  is  not  striking.  If,  how- 
ever, congenital  cases,  habitual  criminals,  drunkards,  prosti- 
tutes, paupers,  etc.,  be  considered,  the  percentage  is  from  85 
to  95  per  cent.  Stigmata,  as  has  been  shown  in  the  chapter 
on  development  of  the  face  and  jaws,  appear  before  or  at  the 
sixth  year.  This  illustrates  conclusively  that  the  brain  cen- 
ters which  preside  over  the  osseous  development  are  affected 
at  or  soon  after  birth. 

In  the  present  state  of  our  knowledge  of  brain  development, 
the  question  arises,  why  is  it  that  two  persons  possessing  the 
same  deformities  of  the  head,  face,  jaws  and  teeth,  one  is  a 
criminal,  idiot,  inebriate,  pauper,  the  other  a  business  man 
or  genius  ?  The  answer  naturally  suggests  itself,  that  while 
the  nerve  centers  of  the  brain  which  preside  over  the  develop- 
ment of  the  osseous  system  are  the  same  in  both  cases,  pro- 
ducing the  same  results,  other  nerve  centers  of  the  brain 
which  preside  over  the  intellect  continue  to  develop  in  the 
second  period  of  brain  growth,  between  the  sixth  year  and 
puberty.  Character  maitures pari  ■passu  with  other  develop- 
ment; the  whole  period  of  youth  is  a  formative  one,  and  it 
cannot  or  ought  not  be  unduly  handicapped  by  an  osseous 
system  practically  fixed  in  the  first  decade  of  existence. 
These  cells  may  develop  in  one  line  producing  genius,  or  they 
may  develop  uniformly,  producing  a  well-balanced  brain.  In 
the  other  case,  the  nerve  centers  in  the  second  period  remain 
undeveloped,  and  the  idiot,  criminal,  inebriate,  pauper  and 
prostitute  results.  Thus  we  find  stigmata  in  persons  possess- 
ing a  normal  brain,  and  it  is  possible  to  find  neurotics  and 
degenerates  with  a  normal  osseous  development. 

It  will  now  be  seen  why  modern  medical  j  urisprudence.  in 
passing  an  opinion  on  a  case  of  alleged  idiocy,  insanity, 
inebriety,  prostitution,  pauperism,  criminality,  etc.,  should 
take  particular  care  to  examine  the  face  and  jaw  external  and 


250  ETIOLOCY   OF  OSSEOUS   DEFORMITIES 

internal,  thereby  tixing  the  date  of  abnormal  development 
due  to  inherited  or  congenital  defect. 

Regarding  the  comparative  degeneracy  of  foreigners  and 
Americans,  it  seems  probable  that  stigmata  are  not  as  marked 
in  American-born  criminals  as  in  foreign.  This  seems  due  to 
the  fact  that  in  the  old  world,  consanguinity,  long  lines  of 
drunkards  and  prostitution,  and  marriage  of  criminals,  have 
had  great  intluence  upon  these  aberrations.  Scientists  and 
specialists  in  this  country  are  of  the  opinion  that  the  more 
marked  degenerate  types  are  imported  individuals.  As  this 
country  develops  in  age  with  the  large  immigration  of  foreign- 
ers, together  with  our  own  criminals,  paupers,  etc.,  these 
excessively  marked  degenerates,  as  illustrated  by  Lombroso, 
Ferri,  Manouvrier  and  others,  will  become  more  numerous. 
In  an  examination,  by  the  aid  of  a  magnifying  glass,  of  the 
photographs  of  epileptics  and  insane  criminals  in  Lombroso' s 
atlas — L'Homme  Criminel — although  these  are  very  small 
and  indistinct,  the  following  deformities  of  the  face  and 
laws  are  found: 

Arrest  of  the  bones  of  the  face  and  superior 

maxillse,         -  -  -         -         -         -  98 

Arrest  of  the  lower  jaw,        -         -         -      -  32 

Excessive  development  of  the  upper  jaw,    -  11 

In  an  examination  of  photos  of  criminals  in  the  Bertillon 
collection,  in  the  French  Building  at  the  World's  Fair,  the 
following  results  were  obtained  of  145  examined  : 

Arrest  of  bones  of  the  face,        -       -  -  54 

Arrest  from  orbit  to  lower  jaw,         -  -  24 

Arrest  from  zygomse  to  lower  jaw,  -  30 

Arrest  of  lower  jaw,  -         -         -  -  65 

All  have  large,  prominent  noses;  many  sunken  eyes,  and 
not  a  few  are  cross-eyed.  This  attempt  to  classify  these 
deformities  (not  for  the  purpose  of  obtaining  percentages, 
which  is  out  of  the  question  with  pictures)  is  simply  intended 
to  show  that  they  exist  among  degenerates  in  other  countries. 


CHAPTER  XXIV. 

NEUROSES  AND   COMPENSATORY  DEVELOPMENT 
OF  THE  BONES  OF  THE  NOSE. 

It  would  be  difficult  to  understand  why  the  bones  and  soft 
tissues  of  the  nose  are  not  just  as  liable  to  show  stigmata  of 
degeneracy  as  the  facial  and  maxillary  bones.  Indeed,  such 
is  the  case.  Deformities  of  the  nasal  septum,  deflection, 
hypertrophy  and  atrophy  of  the  turbinated  bones,  and  defor- 
mities of  the  maxillary  sinuses,  are  almost  always  associated 
with  arrest  and  excessive  development  of  the  facial  and  max- 
illary bones.  This  is  naturally  to  be  expected;  and,  in  the 
history  of  cases  already^  mentioned,  and  hundreds  of  cases 
examined  by  me  in  the  past  few  years,  there  is  hardly 
a  single  instance  in  which  some  deformity  of  the  nose  is  not 
noticed.  They  are  naturally  associated  together.  While  it 
is  possible  to  occasionally  find  deformities  of  the  maxillary 
bones  without  deformities  of  the  nose,  so  it  is  possible  to  find 
deformities  of  the  nose  without  maxillary  deformities.  My 
experience  has  been  that  there  are  very  few  normal  septa. 

Theile  examined  117  skulls  and  found  the  septum  nor- 
mally placed  in  29.  Semeleder  examined  49  and  found  the 
deflection  to  the  left  in  20,  to  the  right  in  15,  and  a  sigmoid 
deformity  in  4.  Harrison  Allen,  in  58  skulls,  found  narrow- 
ing to  the  left  side  in  19,  to  the  right  in  21;  in  six  of  the 
latter  the  septum  and  superior  and  middle  turbinated 
bones  met. 

Zuckerkandl  believed  that  the  dry  skulls  did  not  give  an 
accurate  illustration  of  the  true  condition,  and  then  made  his 
researches  upon  the  cadaver.  Out  of  370  cases  he  found  123 
symmetrical,  and  110  asymmetrical;  in  the  deformed  speci- 
mens, the  septum  was  inclined  to  the  right  in  57  cases,  to  the 
left  in  51,  and  was  sigmoid  in  32.  Mackenzie  examined 
2,152  skulls  in  the  Museum  of  the  Royal  College  of  Surgeons 
and  found  1,657  cases  where  the  septum  was  more  or  less 
deformed.     In  834  the  deviation  was  to  the  left,  and  in  609 

251 


252  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

to  the  ri^ht.  In  205  the  deflection  was  sigmoid,  while  in  5 
the  irregularity  was  zigzag,  showing  TO  per  cent  of  deformi- 
ties in  the  dry  skulls,  and  only  40  in  the  cadaver.  Heyraan's 
examination  showed  90  per  cent  of  deformities  in  living  sub- 
jects. With  the  status  already  shown,  there  seems  to  be 
quite  a  difference  in  the  percentage  of  deformity  as  regards 
races.  Thus  Zuckerkandl  found  in  103  cases  of  barbarous 
and  semi-barbarous  people  24  were  asymmetrical.  Mackenzie 
found  in  430  skulls  of  superior  races  22.6  per  cent  of  defor- 
mities, and  also  confirms  the  observation  of  Zuckerkandl. 

Harrison  Allen  found,  in  93  skulls  of  negroes,  deformity 
of  the  septum  in  21.5  per  cent.  The  author  has  examined 
over  11,000  skulls  in  this  country  and  Europe,  including  the 
large  collection  in  the  Museum  of  the  Royal  College  of  Sur- 
geons, and  347  living  individuals,  with  the  following  results: 
Owing  to  the  fragility  of  the  septum  the  whole  or  anterior  part 
was  lost  in  many  of  the  skulls,  the  result  of  which  only  Y,600 
had  sufficient  bone  remaining  to  give  any  idea  of  its  shape. 
My  examination  of  skulls  in  the  Royal  College  of  Surgeons, 
London,  practically  tallies  with  Mackenzie.  In  the  7,600 
skulls,  5,762  showed  marked  deformities.  Out  of  687  ancient 
Peruvian  skulls,  147  possessed  deflection  of  the  septum.  In 
69  stone-grave  Indians,  35  were  normal  and  34  deformed.  In 
18  mound-builders,  8  were  normal,  10  deformed;  6  California 
Indians,  4  were  normal. 

Dr.  J.  M.  Whitney,  of  Honolulu,  brought  28  skulls  of 
ancient  Hawaiians  to  the  Columbian  Dental  Congress  which 
met  in  Chicago,  August  14th,  1893.  These  were  taken  from 
lava  caves.  There  is  no  question  of  their  antiquity,  many  of 
them  possessing  the  appearance  of  the  Neanderthal  skull. 
The  jaws  were  unusually  well  developed,  as  well  as  the  bones 
of  the  face.  The  external  bones  of  the  nose  were  also  well 
formed.  While  there  was  a  lack  of  that  marked  asymmetry 
due  to  excessive  arrest  of  development  of  the  turbinated 
bones,  as  noticed  in  the  Peruvian  skulls,  yet  the  bones  were 
far  from  being  uniformly  located  in  the  cavities  of  the  nose. 
There  were,  however,  two  in  which  the  inferior  turbinated 
bones  were  undeveloped,  only  rudimentary  ridges  being  pres- 


THE    PIEAD,    FACE,    JAWS    AND   TEETH  253 

ent.  Deflection  of  the  septum  was  noticed  in  23  cases — some 
in  the  anterior  part  of  the  bone,  others  in  the  middle,  and  still 
others  in  the  posterior  part.  In  the  two  cases  where  the 
inferior  turbunated  bone  was  undeveloped  the  septum  deflected 
to  that  side.  Nature  not  seeming  to  be  satisfied  with  the 
amount  of  material  at  hand  built  out  projections  which  seemed 
to  take  the  place  of  the  missing  turbinated  bones.  One  very 
singular  case  was  observed  where  the  deflection  commenced 
midway,  from  before  backwards,  the  greatest  deformity  being 
three-fourths  its  distance  into  the  left  cavity,  midway  between 
the  turbinated  bones.  Upon  that  side  of  the  vomer  there  was 
a  large  ridge,  its  greatest  projection  being  about  .25  of  an  inch 
in  length.  Upon  the  opposite  side  there  was  another  smaller 
ridge,  evidently  for  the  purpose  of  supporting  the  deflected 
point,  and  also  for  the  purpose  of  affording  greater  surface 
for  mucous  membrane  and  blood-supply.  Of  the  347  living 
persons,  107  showed  deflection  of  the  septum. 

I  have  shown,  like  deformities  of  the  other  bones  of  the 
cranium,  face  and  jaw,  that  it  makes  no  difference  whether 
the  individual  was  of  the  ancient  or  modern,  barbarian  or 
civilized,  all  possess  these  deformities  of  the  septum.  No 
two  are  alike,  nor  can  we  find  any  one  growth  resembling 
another  in  number.  Loewenberg,  Mackenzie  and  Ingalls 
have  classified  these  deformities,  but  the  author  will  not 
attempt  to  do  so  for  two  reasons;  prst^  he  did  not  study  the 
deformities  with  that  object  in  view;  and,  second^  from  years 
of  observation  he  is  of  the  opinion  that  each  case  is  a  peculi- 
arity in  itself. 

I  have  given  these  figures  in  detail  because  it  will  be  seen 
that  in  the  original  examination  of  the  skulls  of  the  cadaver 
and  living  individuals,  there  is  no  uniformity  in  the  figures. 
The  author  does  not  believe  that  it  makes  any  difference  in 
the  deformity  of  the  septum  whether  the  subject  is  alive,  on 
the  dissecting  table,  or  the  skull  has  been  grinning  from  the 
shelf  of  a  museum  for  twenty  years.  The  two  points  of 
attachment  are  fixed  (if  the  patient  has  reached  puberty),  and 
the  septum,  green  or  dry,  cannot  very  well  change  its  posi- 


254:  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

tion,  except  that  there  may  not  be  quite  so  marked  a  deflection 
in  the  dry  subject. 

If  the  deformity  were  of  a  sigmoid  nature  upon  one  side, 
or  the  shape  of  the  letter  S,  the  part  of  the  bone  or  cartihige 
being  dry  would  prevent  its  changing  to  the  opposite  side  in 
the  one  case,  or  a  reversal  of  the  S-shape  in  the  other.  It  is 
easy  to  see  why  it  is  more  difficult  to  diagnose  deflection  of 
the  septum  in  the  living  subject  or  cadaver  than  in  the  dry 
skull,  on  account  of  the  soft  tissues  located  in  the  anterior 
part  of  the  nose.  This,  no  doubt,  will  account  for  the  small 
percentage  of  deformities  reported  by  Zuckerkandl  and  the 
author.  I  found  great  difficulty  in  making  my  examinations 
upon  living  individuals;  indeed,  I  am  well  aware  of  the  fact 
that  it  is  almost  impossible  to  discover  the  contour  of  the 
vomer  in  its  middle  and  posterior  parts,  where  they  are  as  fre- 
quently observed  as  in  the  anterior  part.  This  deformity  was 
of  all  manner  of  shapes,  sometimes  like  the  letter  S,  again 
the  letter  C,  and  often  like  the  small  italic  letter  f.  Some- 
times it  would  be  carried  over  so  far  as  to  approximate  the 
right  or  left  outer  wall  of  the  nose.  From  the  fact  that  it  is 
attached  throughout  at  its  upper  and  lower  border  to  a  solid, 
bony  frame-work,  its  middle  portion  is  liable  to  bend  in  any 
direction  like  a  loose  sail  in  the  wind.  Deflection  of  the 
vomer,  due  to  fracture  of  the  cartilage,  or  the  deflection  of 
anterior  part  of  the  nose,  is  easily  differentiated  from  a  fract- 
ured vomer. 

Several  theories  have  been  advanced  as  to  the  cause  of 
these  deformities.  Qnelmalz  and  Schultz  believe  that  they 
are  due  to  the  action  of  astringents  drying  up  the  membrane, 
causing  it  to  contract,  thus  drawing  the  bone  and  cartilage 
down  upon  itself.  Morgagni  believed  that  it  was  "due  to 
excessive  development  of  the  vomer.  The  view  held  by  many 
is  that  advanced  by  Trendelenburg,  that  it  is  due  to  a  crowd- 
ing up  of  a  high-arched  palate,  as  he  had  observed  the  two 
conditions  so  frequently  connected.  Jarvis  has  reported  four 
cases,  all  in  the  same  family,  which  would  suggest  that  it  is 
due  to  an  hereditary  taint.  It  would  be  very  difficult  to 
establish  this  theory  because  of  its  frequency.     If  the  doctor 


THE     HEAD,    FACE,    JAWS   AND   TEETH  255 

had  said  that  the  neurotic  or  degenerate  conditions  which 
underlie  the  building  up  of  the  system  were  inherited,  it 
would  seem  to  me  to  be  more  plausible.  Schaus'  and 
Welcker's  investigations  tend  to  show  that  there  is  a  faulty 
development  of  the  facial  skeleton,  but  in  just  what  manner 
it  is  impossible  to  say.  The  author  agrees  with  this  theory. 
Bosworth*  and  others  believe  that  septal  deformities  are  due 
to  traumatism.  Bosworth  says,  page  288:  "The  clinical  his- 
tory of  many  of  these  cases  affords  direct  evidence  of  this, 
and  even  in  those  cases  in  which  the  direct  injury  is  not  tes- 
tified to,  I  think  it  safe  to  say  that  an  injury  has  occurred, 
which  may  have  been  of  so  slight  a  character  as  not  to  have 
excited  especial  attention  at  the  time  of  the  occurrence.  An 
injury  to  the  nose  need  not  necessarily  give  rise  to  the 
immediate  development  of  a  notable  deformity,  as  in 
fracture,  but  it  may  set  up  a  low  grade  of  morbid 
action,  which,  going  on  through  a  number  of  years,  will 
finally  develop  a  condition  by  which  the  normal  function 
of  the  nose  is  seriously  hampered."  He  also  says,  on  page 
291:  "The  point  on  which  I  would  lay  special  emphasis  is 
that  the  deformity  is  primarily  the  result  of  traumatism,  and 
secondarily  of  a  slow  inflammatory  process  which  results 
therefrom."  That  a  very  few  cases  of  deformity  and  fracture 
of  the  septum  are  due  to  traumatism,  I  believe  to  be  true. 
The  author  is  well  aware  of  the  fact  in  one  case  in  particular, 
when  a  boy  of  sixteen,  he  asserted  his  rights,  when  he 
received  a  blow  upon  the  nose  from  his  opponent  which  fract- 
ured the  cartilage  and  made  a  lasting  impression  upon  him. 
That  from  50  to  80  per  cent,  or  even  5  per  cent  of  deformi- 
ties of  the  septum,  are  due  to  such  injuries,  I  believe  to  be 
out  of  the  question.  In  the  large  number  examined  by  the 
author,  2,684  possessed  what  appeared  to  be  fracture.  The 
vomer  in  many  of  these  specimens  commenced  to  deflect  at 
its  outer  surface  and  gradually  deepened  until,  at  about  its 
middle  or  posterior  two-thirds,  it  reached  its  deepest  part  and 
then  gradually  decreased  in  depth  until  the  posterior  attach- 
ment was  reached.     Its  appearance  was  not  unlike  the  sail  of 

*  "Diseases  of  the  Nose  and  Throat." 


250  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

a  ship.  On  the  convex  surface,  in  many  cases,  nature  had 
thrown  out  provisional  bone  to  support  this  curvature,  M'hich 
might  be  considered  a  break,  but  in  most  cases  simply  a 
bend.  That  a  blow,  whether  slight  or  as  powerful  as  could 
be  given  by  a  Corbett,  could  produce  a  fracture  of  the  vomer, 
the  greatest  deformity  of  which  is  located  from  .75  to  two 
inches  inside  the  nose  from  the  point  of  the  nasal  spine,  would 
hardly  look  reasonable.  Anterior  and  posterior  to  this  deflec- 
tion, the  vomer  appeared  in  most  cases  to  be  nearly  or  quite 
normal.  In  nearly  every  case  the  fracture  would  involve 
only  one-half  of  the  vomer,  the  other  simply  bending;  so  that 
such  a  condition  could  be  brought  about  by  a  blow  is  absurd. 
It  seemed  that  the  point  of  the  greatest  deformity  was  the 
thinnest  part  of  the  bone. 

It  would  appear  to  be  a  very  easy  matter  in  the  skull  to 
decide  whether  a  fracture  had  taken  place  before  or  after 
complete  ossification  by  the  character  of  the  wound,  thuS 
approximating  the  date  of  the  injury.  That  it  was  caused  by 
a  low  form  of  inflammation,  set  up  as  a  result  of  a  slight 
injury  in  utero  or  after  birth,  does  not  seem  to  be  a  rational 
theory,  because  the  inflammatory  condition  must  necessarily 
extend  upon  both  sides  of  and  through  the  septum,  extending 
its  entire  length.  If  due  to  an  inflammatory  condition  the 
bend  or  break  would  be  found  at  any  part  of  the  septum,  and 
the  position  and  shape  would  be  difierent  in  every  case.  As 
the  location  upon  the  septum,  from  above  downward,  is 
nearly  always  the  same,  and  as  the  shape  is  always  from 
before  backward,  inflammation  could  not  produce  it.  In 
order,  therefore,  to  produce  a  fracture,  we  must  first  have  an 
excess  of  septum.  Therefore,  unless  the  fracture  is  the  result 
of  a  direct  blow,  it  would  require  years  to  produce  sufficient 
growth  and  curvature  to  produce  a  condition  in  which  fract- 
ures, or  even  an  abrupt  bending,  could  take  place. 

The  theory,  then,  that  the  deformity  is  "primarily  *'  the 
result  of  traumatism  due  to  injury  in  utero^  or  at  the  time  of 
delivery,  or  even  subsequently,  except  by  direct  force,  and 
secondarily  to  a  slow  inflammatory  process,  to  my  thinking, 
will  not  account  for  these  deformities.       Indeed,  fracture  of 


THE    HEAD,    FACE,    JAAVS    ANJ)    TEETH 


L^57 


soft  tissue,  such  as  the  vomer  before  ossitication,  is  not  p(^ssi- 
ble.  The  theory  advanced  by  Trendelenburg,  and  supported 
by  many  specialists  today,  is  so  absurd  that  it  would  seem 
almost  unnecessary  to  say  anything  about  it  at  this  time,  but 
as  this  theory  is  still  taught  in  our  medical  colleges,  I  deem 
it  necessary  to  call  the  attention  of  specialists  to  some  of  its 
absul-dities.  I  will  say,  however,  at  the  start,  that  wherever 
we  find  a  high,  contracted  vault,  we  also  observe  a  deflected 
septum.  Often,  however,  a  deflected  septum  .is  found  with- 
out a  high,  contracted  vault.  While  the  high  vault  and 
deflected  septum  go  hand  in  hand,  the  one  does  not  produce 
the  other.     It  has  been  shown,  in  the  chapter  upon  the  devel- 


Fig.  70. 

opment  of  the  vault,  that  it  is  developed  downward  and  not 
up.  The  development  of  the  suture,  which  unites  at  the 
median  line,  is  precisely  like  laying  the  keel  of  a  ship,  only 
upside  down ;  it  is  laid  first  and  is  the  foundation  upon  which 
the  superstructure  rests.  The  narrow,  contracted  vault  is 
never  seen  before  the  sixth  year,  except  in  cases  of  monstros- 
ities. Many  septa  are  deformed  before  that  date.  There  is 
nothing,  then,  to  cause  the  upward  movement  of  the  vault. 
The  ridge  is  not  the  result  of  a  pushing  down  of  the  suture 
by  the  vomer.  The  vomer  would  have  to  become  taut  to 
accomplish  this,  but  we  always  find  it  bent  in  such  cases. 
Again,  if  the  ridge  was  produced  by  the  action  of  the  vomer 
it  would  be  nearly  or  quite  uniform  in  thickness  its  entire 
length,  but  this  is  never  the  case.       If  it  were  possible  to 


258  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

crowd  down  the  middle  and  posterior  palate,  it  would  bo 
impossible  to  crowd  down  the  anterior  part  of  the  palate,  which 
is  covered  by  the  anterior  alveolar  process.  I  have  fre- 
quently observed  a  ridge  extending  along  and  including  the 
alveolar  process  as  far  as  the  incisor  teeth.  I  have  examined 
1,367  skulls  containing  vaults  so  depressed,  but  have  never 
been  able  to  find  a  corresponding  depression  in  the  floor  of 
the  nose. 

Again,  it  would  be  as  impossil)le  to  force  down  the  vault 
at  the  median  line  as  it  would  be  to  force  a  keystone  through 
a  brick  or  stone  wall  by  the  weight  resting  upon  it.  The 
author,  and  others,  have  shown    that    deformed    septa   are 


Fig.  71. 

common  among  early  and  pure  races,  who  do  not  possess  con- 
tracted arches;  so  that  it  will  be  seen  that  one  is  not  depend- 
ent upon  the  other.  As  regards  the  length  of  the  septum,  I 
agree  with  Morgagni,  that  it  has  developed  beyond  its  normal 
size,  and  in  order  that  it  may  accommodate  itself  to  its  sur- 
roundings, it  must  deflect  either  to  the  right  or  left.  Sta- 
tistics show,  in  some  cases,  that  the  right  side  has  the  prefer- 
ence; others  show  that  the  left  side  is  more  favored,  and 
again,  that  it  is  about  evenly  divided  as  regards  deformities. 
Let  us  now  examine  some  of  these  cases  and  see  if  we 
can  throw  any  light  upon  this  subject.  The  first  seven  cases 
are  Peruvian  skulls  from  Harvard  college.  Figs.  70  to  73, 
inclusive,  are  well  developed,  while  Figs.  74,  75  and  76  are 
arrested  in  their  development.     These  photos  were  taken  by 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


259 


a  regular  photographer,  and  were  arranged  so  as  to  get  as 
much  light  into  the  cavities  as  possible.  Some,  however,  are 
quite  unsatisfactory,  for,  while  they  show  the  septum,  the 
turbinated  bones  and  surrounding  parts  are  not  well  illus- 
trated. Fig.  TO  shows  the  septum  deflected  to  the  left — rest- 
ing upon  the  inferior  turbinated  bone  of  that  side.  The 
right  turbinated  bones  (which  are  poorly  shown)  are  excess- 
ively developed,  to  such  an  extent  that  while  they  do  not 
quite  touch,  they  take  the  contour  of  the  nasal  septum.  Fig.  71 
shows  a  similar  condition,  while  the  nasal  septum  is  not 
deflected  quite  as  far.  The  right  superior  turbinated  bone  is 
excessively  developed,  but  not  to  the  extent  of  the  inferior 


Fig.  72. 

one.  Fig.  72  shows  a  septum  almost  straight.  The  left 
inferior  turbinated  bone  is  nicely  shown.  The  other  turbi- 
nated bones  are  also  excessively  developed,  but  do  not  extend 
so  far  forward.  Also  notice  that  the  septum  is  divided  into 
two  parts.  It  will  be  observed  that  in  the  other  two,  unlike 
this  one,  the  turbinated  bones  are  arrested  in  their  develop- 
ment upon  one  side,  and  excessively  developed  upon  the 
other.  Both  cavities  are  entirely,  but ,  uniformly,  filled  with 
complete  masses  of  soft,  spongy  portions  of  the  turbinated 
bones.  Stigmata  of  degeneracy  are  marked  all  over  the 
skulls,  while  the  cavities  of  the  nose  are  smaller,  or  arrested 
in  their  development.  The  two  sides  of  the  face  are  quite 
unlike,  and  the  orbits  are  very  much  undeveloped.  There  is 
a  marked  arrest  of  development  of  the  left  maxillary  bone, 


260 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


which  contains  an  antrum  only  about  one-half  the  size  of  the 
right  side.  The  arrest  of  development  has  caused  the  teeth 
to  be  forced  out  on  a  large  circle,  in  order  that  they  may 
come  in  contact  with  the  lower  teeth.  This  action  has  caused 
the  roots  of  the  teeth,  in  many  cases,  to  protrude  through  the 
outer  plate  of  alveolar  process.  The  mastoid  processes  are 
also  excessively  developed.  A  profile  view  was  taken  of 
this  skull  (Fig.  73)  in  order  to  obtain  as  good  a  view  as  pos- 
sible of  the  large  right  inferior  turbinated  bone.  This  bone 
is  so  large  that  it  extends  nearly  to  the  floor  of  the  cavity. 
The  most  remarkable  point  in  regard  to  this  deformity,  out- 
side of  the  excessively  developed  turbinated  bones,  is,  that 


Fig.  73. 

not  only  is  the  septum  deflected  to  the  left  until  it  rests  upon 
the  wall  of  the  cavity,  but  that  the  nasal  spine  is  alsodeflected. 
Fig.  71  shows  nasal  cavities  arrested  in  their  development. 
The  septum  is  but  slightly  curved  to  the  left.  The  nasal  cav- 
ities are  filled  with  excessively  developed  turbinated  bones, 
and  the  spaces  between  the  turbinated  bones  and  the  vomer 
are  about  evenly  divided.  Fig.  75  shows  a  very  small  nose, 
the  vomer  is  deflected  to  the  left  below,  and  at  about  one- 
third  of  the  way  up  it  takes  a  decided  turn  to  the  right.  In 
the  examination  of  the  turbinated  bones  the  right  inferior 
bone  is  very  large,  the  left  very  small,  while  the  reverse  is 
the  case  in  the  two  upper  bones.  Fig.  76  also  shows  stig- 
mata of  degeneracy  in  the  nasal  cavities.  Here  the  vomer  is 
about  straight,  while  the  turbinated  bones   upon  both  sides 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


261 


are  so  large  that  they  fill  the  cavities;  the  spaces  between, 
however,  are  uniform  upon  both  sides.  We  have  now  seen 
that  deflection  of  the  septum  and  excessive  development  of 
the  turbinated  bones  are  associated  with  large,  well-formed 
nasal  cavities,  as  well  as  with  small,  contracted  cavities  in 
ancient  as  well  as  modern  people.  The  same  relation  exists 
between  the  vomer  and  turbinated  bones  in  all  the  skulls  as  M^ell 
as  in  living  persons.  The  extent  and  location  of  the  deformity 
depends  upon  the  extent  of  development  and  location  of  the 
turbinated  bones.  They  may  not  necessarily  be  excessively 
developed  or  arrested  in  their  development,  but  if  the  outer 
walls  are  small,  reducing  the  size  of  the  nasal  passages,  and 


Fig.  74. 

the  turbinated  bone  unevenly  situated  or  nearly  filling  the 
cavity,  the  septum  will  deflect  to  the  right  or  left  and  conform 
to  their  shape,  leaving  uniform  spaces  throughout  the  entire 
length  of  the  bone.  Inhalation  and  exhalation  cause  the 
vomer  before  or  during  ossification  to  deflect  to  the  right  or 
left,  according  to  the  size  and  location  of  the  turbinated 
bones.  The  air  striking  the  septum,  just  as  the  wind  strikes 
the  sail  of  a  boat,  produces  uniform  spaces  between  the  sep- 
tum and  turbinated  bones.  The  bend  or  breakage  is  almost 
invariably  at  a  point  of  the  concavity  just  midway  between 
the  two  turbinated  bones  on  that  side,  and  at  the  thinnest 
part  of  the  vomer.  When  the  turbinated  bones  are  unde- 
veloped upon  one  side  and  excessively  developed  upon  the 
other,  the  force  of  air  causes  the  vomer  to  bend  toward  the 


262 


i<:tiology  of  osseous  deformities  of 


smaller  turbinated  bone,  thus  lengthening  it,  so  that  the  air 
will  enter  and  leave  uniformly  upon  both  sides,  as  illustrated 
in  Figs.  TO  and  71.  If  the  turbinated  bone  is  large  upon  one 
side,  the  force  of  air  will  cause  the  unossified  vomer  to 
develop,  and  if  the  cavity  of  the  nose  is  large,  the  whole  vol- 
ume of  air  will  eventually  strike  the  vomer  upon  one  side, 
causing  it  to  bend  right  or  left  until  the  air  is  uniformly'  dis- 
tributed or  it  comes  in  contact  with  the  turbinated  bones  upon 
the  opposite  side.  In  Figs.  74  and  76,  the  turbinated  bones, 
developing  nearly  uniformly  upon  both  sides  and  filling  the 
nasal  cavity,  give  no  opportunity  for  the  septum  to  deflect  to 
the  right  or  left.      The  spaces,  therefore,  are  uniform  upon 


Fig.  75. 

both  sides.  It  is  also  safe  to  say  that  when  these  bones  are 
covered  with  mucous  membrane  that  the  nose  was  com- 
pletely filled,  and  that  these  persons  were  mouth-breathers. 
Associated  with  unstable  development  of  the  superior 
maxilla  and  bones  of  the  nose,  we  must  necessarily  bave 
unstable  development  of  the  mucous  membrane,  resulting  in 
a  thickening  of  the  membrane  and  adenoid  growths.  These 
conditions  are  almost  always  to  be  found  in  connection  with 
stigmata  of  degeneracy.  We  can  now  see  why,  in  idiocy, 
imbecility,  etc. ,  patients  possessing  (apparently)  high  vaults, 
are  mouth-breathers.  There  is  an  arrest  of  development  of 
the  bones  of  the  face,  jaw  and  nose.  The  patient  cannot 
breathe  through  the  nose;  the  mouth  being  open  the  teeth 
and  alveolar  process  develop  down  for  want  of  antagonism; 


THE     HEAD,    FACE,    JAWS    AND   TEETH  263 

and  the  contracted  vault,  which  looks  high  because  of  the 
arrest  of  development,  results. 

It  is  quite  common  to  find  entire  arrest  of  the  inferior 
turbinated  bones  upon  one  side  or  upon  both  sides.  Again, 
one  or  both  inferior  turbinated  bones  will  be  partially  devel- 
oped. 

The  following  skulls,  in  the  Army  Medical  Museum  at 
Washington,  possess  such  deformities: 

Alaska  Indians — 

Skull  No.  1,090,  case  177;  lower  right  turbinated  bone 
undeveloped. 

Skull  No.  1,092,  left  inferior  turbinated  bone  unde- 
veloped, vomer  gone. 

Skull  No.  1,094,  both  inferior  turbinated  bones  unde- 
veloped. 

Skull  No.  2,431,  no  inferior  turbinated  bone. 

Skull  No.  2,453,  no  inferior  turbinated  bone. 

Skull  No.  2,798,  no  inferior  turbinated  bone. 

Skull  No.  2,451,  no  left  inferior  turbinated  bone. 

Skull  No.   1,216,  case  180;  both  inferior  turbinated 
bones  undeveloped. 
Many  Peruvian  skulls  show  undeveloped  inferior  turbin- 
ated bones.     Thus: 

Skull  No.  630,  case  166;  no  right  inferior. 

Skull  No.  631,  case  166;  no  right  or  left  inferior. 

Skull  No.  115,  case  167;  no  left  inferior  turbinated 
bone.  Individual  over  twenty-two  years  of  age  at 
time  of  death. 

Excessive  development  of  the  turbinated  bones  is  also 
very  common.  Thus,  No.  2,131,  case  175,  Vancouver  Island 
Indians:  The  right  middle  turbinated  bone  is  excessively 
developed,  so  that  it  fills  the  anterior  middle  of  the  nasal  cav- 
ity with  a  large  cavity  in  the  center.  The  left  middle  and 
right  and  left  inferior  bones  were  well  developed,  filling  both 
nasal  cavities.  In  this  case  the  vomer,  which  stands  uni- 
formly between  the  turbinated  bones  takes,  the  shape  of  the 
letter  S.     No.   2,129,  Vancouver  Island  Indians,  shows  left 


264 


KTIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 


superior  turl)inated  bones;  excessively  developed  to  a  level 
with  middle  turbinated  bone.  The  vomer  is  deflected  to  the 
right,  then  to  the  left,  in  order  that  it  may  stand  in  a  central 
position.  Skull  1,309,  case  173,  illustrates  the  theory  of  the 
author  very  nicely.  The  right  middle  turbinated  bone  unde- 
veloped, interior  right  excessively  developed;  the  vomer  at 
its  middle  takes  a  V-shape,  in  order  that  it  may  stand  in  the 
middle  between  the  turbinated  bones. 

That  inhalation  and  exhalation  govern  the  development 
and  shape  of  the  bones  of  the  nose  is  nicely  illustrated  in  many 
ways.  When  the  nasal  cavities  are  small  and  the  bones 
become  enlarged  upon  one  side,  the  outer  wall  will  become 


Fig.  76. 

concave,  encroaching  upon  the  antrum.  Again,  when  the  nasal 
cavities  are  small,  the  turbinated  bones  will  develop  and  curl 
upon  themselves  so  that  uniform  space  is  obtained  for  the 
passage  of  air.  In  a  long,  narrow  nasal  passage  the  bones 
will  develop  long  and  narrow;  the  superior  turbinated  bone 
will  develop  down,  sometimes  below  the  lower  edge  of  the 
superior  turbinated  bone.  In  other  cases  the  nasal  cavities 
will  be  short  and  broad.  In  these  cases  the  bones  will 
become  large  and  short.  I  have  seen  them  develop  straight 
out  from  the  outer  wall,  and  then  turn  upon  themselves  back 
to  the  point  of  origin.  Sometimes  they  are  very  thin  and 
dense,  like  the  vomer.  Again,  they  are  thick  and  cancellated, 
like  the  spongy  alveolar  process.  Occasionally  one  nasal 
cavity  will  be  lower  than  the  other.       In  such  cases  a  corre- 


THE    HEAD,    EACE,    JAWS   AND    TEETH 


26; 


sponding  deformity  is  almost  sure  to  result  in  the  vault. 
When  the  nasal  cavities  are  not  uniform  in  development — that 
is,  narrower  in  front  than  behind — the  turbinated  bones  will 
develop  posteriorly,  and  either  become  undeveloped  anteriorly 
or  will  curve  more,  so  that  air  may  be  evenly  distributed 
throughout  the  cavity.  When  the  turbinated  bone  develo))S 
larger  or  smaller  behind  than  in  front,  the  bone  will  bend 
upon  itself  to  conform  to  this  deformity. 

Skull  No.  736,  case  179,  has  also  a  very  marked  deformity 
of  the  vomer;  it  is  bent  in  both  directions.  The  anterior  half 
is  midway  between  the  turbinated  bones,  while  the  posterior 
half  is  bent  to  the  right,  the  greatest  point  being  between 


Fig.  77. 

the  right  upper  and  lower  turbinated  bones.  Both  concavi- 
ties have  projections — one  to  the  right,  the  other  to  the  left. 
The  anterior  curvature  of  the  vomer  is  the  largest,  and  for 
this  reason  the  left  turbinated  bone  is  undeveloped.  This, 
however,  does  not  allow  sufficient  room  for  the  air  to  become 
evenly  distributed  through  the  nostril  upon  one  side.  The 
most  remarkable  thing  is  that  to  procure  room  the  air  had 
forced  the  vault  of  the  mouth  on  that  side  downward,  making 
a  very  marked  and  noticeable  deformity.  The  dental  arch  is 
well  developed. 

Occasionally  the  turbinated  bones  are  so  situated  that  the 
air  will  deflect  the  vomer  to  one  side  or  the  other  in  such  a 
manner  that  there  will  be  a  deformity  at  right  angles,  just 
below  the  inferior  turbinated  bone.     This,  however,  cannot 


266 


ETIOLOGY   OF   OSSEOUS  DEFORMITIES   OF 


be  located  very  near  its  place  of  attachment,  for  the  reason 
that  the  vomer  commences  to  enlarge  or  thickens  as  it  reaches 
the  nasal  spine,  thus  preventing  the  bend. 

The  drawings  of  Zuckerkandl  arc  here  given  because  they 
illustrate  the  very  points  which  I  have  made,  and  because  they 
are  true  to  life. 

Fig.  77  shows  the  bone  very  unevenly  developed.  This 
is  partly  due  to  an  excessively  developed  antrum  upon  the 
left  side  and  a  correspondingly  small  one  upon  the  right  side. 
It  will  be  noticed  that  the  turbinated  bones  and  vomer  are  so 
distributed  that  there  is  a  uniformity  of  space  throughout  the 
cavity.     The  vomer  even  has  deflected  to  the  right  in  order 


Fig.  78. 


to  produce  this  harmony.  It  will  be  observed,  however,  that 
the  bone  is  not  broken,  but  simply  bent,  and  that  this  bend  is 
about  opposite  the  enlarged  left  inferior  turbinated  bone. 
Although  the  face  is  very  asymmetrical,  the  bones,  which  are 
intended  for  the  purpose  of  warming  the  air,  are  nicely 
arranged.  The  right  cavity  is  considerably  lower  than  the 
left;  the  inferior  turbinated  has  lengthened  to  correspond. 
Aspiration  has  separated  the  lateral  halves  of  the  vomer,  and 
the  space  has  filled  in  with  bone. 

Fig.  78  is  quite  another  case.  Here  we  see  the  facial  bone 
uniformly  developed;  the  antra  are  comparatively  uniform; 
the  turbinated  bones,  however,  are  very  unevenly  developed. 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


267 


The  bend  and  break  in  the  vomer  are  about  at  a  point 
between  the  two  turbinated  bones,  and  exactly  opposite  the 
excessively  developed  right  inferior  turbinated  bone.  It  will 
be  observed  that  the  bend  is  no  greater  in  the  one  than  in 
Fig.  77,  and  yet  in  Fig.  78  the  left  plate  is  fractured,  while  the 
right  one  is  slightly  bent.  This  is  usually  the  case.  There 
is  not  a  complete  fracture,  but  a  semi-fracture. 

Fig.  79  shows  still  a  different  condition.  The  left  antrum 
is  nearly  closed;  to  compensate  for  this  a  number  of  sinuses 
are  formed.  In  order  that  the  air  may  be  warmed  uniformly 
the  septum  has  developed  to  the  left.  The  lower  part  has 
enlarged,   and  the   middle  has  deflected  to  the   right,  thus 


Fig.  79. 

giving  a  more  uniformity  of  spaces.     The  right  inferior  tur- 
binated bone  has  also  enlarged  for  the  same  purpose. 

Fig.  80  is  a  splendid  illustration  of  arrest  of  development 
of  the  bones  of  the  face,  nose  and  jaws.  The  bones  are  very 
unevenly  developed,  with  excessive  development  of  the  left 
superior  turbinated  bone,  which  has  a  cavity  in  it  no  doubt 
for  the  purpose  of  producing  more  surface  for  the  blood-sup- 
ply. An  individual  with  such  a  development  must  neces- 
sarily possess  a  degenerate  condition,  with  weak  lungs,  small 
chest,  and  low  vitality.  In  order  that  the  air  may  be  uni- 
formly warmed  the  septum  has  deflected  towards  the  right. 
The  vomer  has  deflected  towards  the  right  in  order  that  the 


268 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


turbinated  bone  may  have  room,  and  also  to  furnish  uniform 
space.     The  septum  in  this  case  is  bent  and  not  broken. 

Fig.  81  is  another  form  of  deformity  which  I  have  occa- 
sionally observed.  In  this  drawing  we  observe  that  the  nasal 
cavities  extend  laterally  nearly  outside  of  the  alveolar  process. 
If  we  were  to  undertake  to  open  the  antrum  through  the 
cavities  of  the  teeth  we  should  drill  into  the  floor  of  the  nose. 
I  have  observed  such  cases.  Having  such  a  large  space  the 
turbinated  bones  have  adjusted  themselves  to  the  best  advan- 
tage. The  septum  also  has  adapted  itself  as  best  it  can  by 
deflecting  toward  the  left  side,  having  bent  itself  at  its  weakest 
part  and  opposite  the  enlarged  turbinated  bone.     There  is, 


Fig.  80. 

however,  a  large  space  upon  the  right  side  between  the  two 
turbinated  bones.  The  thickness  of  the  bone  prevents  its 
being  bent  by  the  pressure  of  air,  and  excessive  development 
of  the  vomer  has  taken  place  upon  that  side  as  a  substitute. 

Fig.  82  shows  the  turbinated  bones  upon  both  sides  exces- 
sively and  uniformly  developed,  the  result  of  which  is  that 
the  vomer  is  straight  upon  the  left  side,  while  the  right  half 
has  been  torn  away,  and  by  aspiration  the  air  has  drawn  it 
slightly  into  the  space  between  the  two  bones. 

Figs.  83  and  84  are  drawings  taken  from  frozen  speci- 
mens in  the  Army  Medical  Museum  at  Washington,  showing 
that  the  parts  of  fracture  and  deflection  are  situated  between 
the  turbinated  bones. 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


209 


Another  illustration,  to  show  how  nature  will  adapt  her- 
self to  abnormal  conditions,  is  nicely  shown  in  a  skull  in  my 
possession  of  a  girl  fourteen  years  of  age,  who  died  of  con- 
sumption. There  is  hardly  a  bone  which  goes  to  make  up  the 
skull,  including  the  lower  jaw,  that  does  not  show  stigmata 
of  degeneracy.  The  left  inferior  turbinated  bone  did  not 
develop.  A  simple  ridge  is  present  where  the  bone  should  be 
attached  to  the  outer  wall.  The  right  inferior  turbinated 
bone  is  excessively  developed.  The  vomer  has  curved  to  the 
side  where  there  is  space  and  from  the  enlarged  right  turbi- 
nated bone.  Although  there  is  quite  a  bend,  owing  to  the  fact 
that  the  girl  died  at  the  age  of  fourteen,  it  did  not  develop 
and  bend  to  the  .extent  that  it  would  had  she  lived. 


Pig.  81. 

Another  case  is  that  of  a  bone  projecting  .36  of  an  inch, 
(situated  upon  the  right  side  of  the  vomer  just  midway  between 
the  superior  and  inferior  turbinated  bones)  .75  of  an  inch  in 
length,  1.50  inch  in  from  the  nasal  spine,  and  .50  of  an 
inch  from  the  posterior  border,  which  is  comparatively 
straight.  The  anterior  part  is  slightly  curved,  but  perfectl}^ 
straight  .50  of  an  inch  anterior  to  the  commencement  of  the 
deformity.  There  is  a  slight  groove  upon  the  opposite  side 
of  the  vomer  to  correspond  to  the  line  of  projection.  It 
stands  just  midway  between  the  two  turbinated  bones.  This 
is  not  a  fracture,  nor  can  we  in  any  sense  claim  that  the  pro- 
jection is  for  the  purpose  of  repairing  a  fracture.  The  length 
of  this  projection  would  also  preclude  such  an  idea.     These 


270 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


projections  vary  from  a  mere  ridge  up  to  a  projection  .36  of 
an  inch  in  width.  It  would  seem  that  nature,  being  unable 
to  develop  the  bone  sufficiently  to  carry  it  far  enough,  built 
out  a  projection  in  order  to  complete  its  design. 

These  projections  were  first  mentioned  by  Langenbeck, 
who  gave  to  them  the  name  of  exostoses.  They  were  after- 
wards described  by  Theile,  Harrison  Allen  and  John  Mac- 
kenzie. "These  projections,"  says  Bosworth,  "are  always 
found  along  the  sutural  lines  of  the  septum,  and  consists  in  a 
more  or  less  well-developed  angular  prominence  or  ridge, 
which,  projecting  into  the  nasal  passage,  acts  to  obstruct 
normal  respiration." 


Fig.  82. 

This  has  not  been  my  experience,  as  I  have  always  found 
them  situated  upon  the  convex  surface,  and  the  greatest  pro- 
jection being  at  the  weakest  point  of  the  septum.  As  the 
greatest  deformity  may  be  located  at  any  point  between  the 
anterior  and  posterior  edges  of  the  bone,  we  are  liable  to  find 
the  greatest  point  of  projection  on  any  part  ot  the  septum, 
but  they  are  always  situated  midway  between  the  turbinated 
bones.  This  projection  I  believe  to  be  due  to  irritation,  the 
result  of  inhalation  and  exhalation. 

From  the  observation  made  it  would  seem  that  the  deflec- 
tion of  the  vomer  was  due  to  a  wise  provision  of  nature.  In 
its  deviation  to  the  right  or  left,  with  a  decided  depression 


THE    HEAD,    FACE,    JAWS   AND    TEETH 


271 


always  at  a  point  where  there  is  the  greatest  space;  sometimes 
in  the  anterior  part  of  the  bone,  and  often  in  its  posterior 
part;  sometimes  high  up,  and  again  low  down,  depending 
upon  the  location  of  the  turbinated  bone,  with  a  rib  of  bone 
developed  upon  its  convex  surface,  which  I  believe  is  nature's 
way  of  supporting  the  deformed  parts.  My  reason  is  that  it 
does  not  extend  the  entire  length  of  the  septum.  It  seems  to 
be  also  intended  for  a  supernumerary  turbinated  bone.  The 
deflection  and  the  supernumerary  turbinated  bone  are  to  com- 
pensate for  the  space  on  either  side  of  the  nose.  Just  as  the 
intelligence  of  the  individual  depends  upon  the  amount  of 
gray  matter  in  the  brain,  and  the  gray  matter  depends  upon 


Pig.  83. 

the  "number  of  lobes  or  convolutions,  so  the  warmth  of  air 
which  is  taken  into  the  lungs  depends  upon  the  amount  of 
blood,  the  blood  upon  the  amount  of  mucous  membrane,  and 
the  mucous  membrane  upon  the  contortion  of  the  bones  of 
the  nose  to  produce  surface.  If  they  are  arrested  upon  one 
side,  those  upon  the  other  enlarge  or  elongate,  and  thus  make 
up  for  the  deformity.  I  have  also  shown  that  when  the 
inferior  turbinated  bone  is  entirely  arrested  the  bend  in  the 
septum  and  projection  seem  to  compensate. for  the  loss.  In 
neurotics  and  degenerates,  in  many  cases,  the  lungs  and  the 
chest  walls  are  undeveloped  and  very  delicate.  Nature 
requires  that  the  air  shall  be  of  a  uniform  temperature  before 
it  is  taken  into  the  lungs. 

The   deformities   take   place   before   puberty,    and  in    a 


272 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


majority  of  cases  before  the  sixth  year.  We  know  this  to  be 
the  case,  because  the  stamp  of  degeneracy  is  placed  upon  the 
face  at  this  time.  The  arrest  of  development  of  the  jaw  takes 
place  at  the  time  the  second  teeth  erupt,  and  the  arrest  of  the 
nose  and  face  shows  that  the  individual  possesses  a  face  of 
that  age. 

The  width  of  the  external  nasal  cavity  varies  consider- 
ably. In  2,000  cases,  the  greatest  width  was  1.25  of  an  inch; 
the  smallest  width  was  .75.  The  length  from  the  nasal  spine 
to  the  edge  of  the  nasal  bones  was  (greatest  length)  1.54  and 
the  smallest  1.20  of  an  inch.  These  skulls,  however,  are 
made  up  of  Peruvians,  stone-grnvc  Indians,  mound-I)uilders, 


Fig.  84. 

cliff-dwellers,  Hawaiians,  etc. ,  etc.  In  neurotics  and  degener- 
ates, when  arrest  of  development  of  the  face  and  nose  had 
taken  place,  I  found  that  the  width  measured  .50  to  .60  of  an 
inch,  and  the  length  .80  to  .90  of  an  inch.  In  these  cases,  if 
the  turbinated  bone  developed  uniformly,  the  vomer  will  be 
straight.  If  asymmetry  exists,  the  vomer  will  be  deflected 
to  one  side  or  the  other,  in  which  case  the  bone,  when  covered 
with  mucous  membrane,  will  fill  the  cavity  of  the  nose  and 
mouth- breathing  will  result. 

Taking  a  general  view  of  the  nose,  in  many  cases  there  is 
a  want  of  harmony  in  its  general  outline.  The  nasal  bones 
become  arrested  in  their  development,  and  the  tip  of  the  nose 
is  turned  up,  owing  to  a  normal  or  excessively  developed 
cartilage.     Another  and  very  marked  deformity  is  one  in 


THE    HEAD,    FACE,    JAWS   AND    TEETH  273 

which  the  nasal  bone  and  cartilage  are  excessively  developed. 
The  bone  takes  one  angle  and  the  cartilage  another,  produc- 
ing a  double  nose.  This  condition  is  very  common  among 
Hebrews.  There  are,  however,  Americans  frequently  seen 
upon  our  streets  who  have  developed  nasal  organs  to  such 
an  extent  that  there  is  material  enough  for  two  fair-sized 
noses.  In  a  majority  of  these  cases  there  is  a  total  collapse 
of  the  walls  of  the  nose,  and  frequently  mouth-breathing 
results. 

Fig.  88  illustrates  such  a  case,  although  the  nose  is  not 
nearly  as  large  as  these  two  I  have  just  alluded  to.  This 
illustration,  however,  gives  a  fair  idea  of  such  cases.  In 
over  2,000  measurements  of  the  nasal  bones,  the  shortest  was 
found  to  be  .40,  the  longest  1.65  of  an  inch  in  length.  It 
will  be  seen  that  even  the  bones  without  the  cartilage  would 
make  a  fair-sized  nose.  These  bones  take  different  angles.  It 
would  seem  that  those  which  are  the  largest  take  the  great- 
est angle.  A  form  of  deformity,  which  is  more  common  than 
is  generally  supposed,  is  that  in  which  the  nose  is  deflected 
to  the  right  or  left.  This  deformity,  however,  is  often  so 
great  that  it  produces  a  marked  asymmetry  of  the  face,  and 
often  so  slight  as  to  be  unnoticed  by  the  average  observer. 
There  is  no  doubt  that  it  is  carried  to  the  right  or  left  by  the 
cartilaginous  septum,  when  only  the  soft  tissues  are  involved; 
but  when  the  bones  of  the  nose  are  deformed,  quite  another 
condition  exists.  Marked  deflection,  as  well  as  other  deform- 
ities of  the  nose,  are  not  observed  in  early  life,  but  as  the 
face  develops  the  deformity  becomes  more  prominent,  and 
at  the  age  of  puberty  is  well  defined,  although  it  does  not 
reach  its  full  development  until  twenty-five  or  thirty  years. 
In  most  every  instance  the  two  lateral  halves  of  the  face  are 
asymmetrical,  as  well  as  the  nasal  bones.  The  bones  of  the 
nose  develop  upon  one  side  and  deflect  the  lower  border  to 
the  opposite  side,  where  the  bones  are  undeveloped.  This 
has  a  tendency  to  deflect  the  cartilaginous  septum  in  the  sauie 
direction,  which,  in  turn,  exaggerates  the  deformity.  The 
author  has  observed  noses  in  neurotics  and  degenerates 
deflected  nearly  45°  from  a  normal  position.     It  has  been 


274  ETIOLOGV  OF  OSSEOUS  DEFORMITIES  OF 

stated  that  these  marked  deflections  are  due  to  injury 
in  ut&i'o  or  at  birth.  As  the  bones  of  the  nose  are  unde- 
veloped at  birth,  and  as  marked  deflection  is  not  observed 
until  later  in  life,  it  would  seem  out  of  place  to  bring  forth 
such  a  theory. 

At  birth  the  nasal  cavities  are  not  evenly  developed. 
Nature  tries  to  correct  this  defect.  If  one  side  is  larger  than 
the  other,  more  air  will  pass  through  one  side  than  the  other. 
If  the  two  sides  are  nearly  even,  the  amount  of  air  will  be 
about  uniformly  distributed. 

Ziem  has  shown  that  if  one  nostril  of  a  rabbit  be  perma- 
nently closed  and  the  animal  killed  after  it  has  attained  its 
full  growth,  the  nasal  cavity  of  the  affected  side  will  be  found 
to  be  undeveloped,  and  asymmetry  of  the  face  will  have  taken 
place.  This  is  also  the  case  when  one  side  is  undeveloped; 
the  air  passes  through  the  opposite  side  and  the  passage 
becomes  enlarged.  A  greater  quantity  of  air  passing  through, 
a  greater  surface  of  mucous  membrane  is  required  to  warm 
it.  The  turbinated  bones  Ijecome  physiologically  enlarged, 
owing  to  the  stimulation  of  the  air,  and  the  vomer  is  carried 
to  the  weak  side.  The  undeveloped  condition  of  the  nose 
and  asymmetry  of  the  face  of  animals,  as  demonstrated  by 
Ziem,  can  be  accounted  for  in  no  other  way  than  a  want  of 
stimulation  of  air  inhaled  and  exhaled. 

The  septum  ossifies  much  slower  than  the  surrounding 
bone,  and  therefore  it  is  more  easily  moved  out  of  its  normal 
position.  At,  or  about  the  sixth  year,  the  deformity  is  well 
established.  The  air  stimulates  a  physiological  development 
of  the  septum,  and  it  bends  toward  the  undeveloped  side.  It 
arows  faster  than  the  points  of  attachment,  and  as  a  result 
the  septum,  according  to  the  law  of  mechanics,  bends  toward 
the  smaller  part.  When  inhalation  takes  place,  the  air  pass- 
ino-  through  the  undeveloped  passage,  produces  suction,  thus 
drawing  the  bone  toward  that  side;  while  upon  the  other 
hand,  the  large  volume  of  air  passing  through  the  large  nos- 
tril, forces  it  in  the  same  direction.  Thus,  by  aspiration  and 
pressure,  the  thinner  part  of  the  bone  is  bent  to  the  weaker 
side,  which  gives  a  uniform  space  for  the  pressure  of  air 


THE    HEAD,    FACE,    JAWS   AND   TEETH  275 

throughout  the  nose.  The  location  of  the  deformity  depends 
upon  the  asymmetry  of  the  two  sides  and  the  thinness  of  the 
vomer.  We  will  frequently  notice,  by  close  examination  of 
section  of  the  vomer  (as  illustrated  in  Figs.  82,  S3  and  84,  and 
also  in  plates  1  A,  1  Band  1  C,  of  "Atlas  of  Head  Sections," 
by  Wm.  Macewin,  M.  D.,  just  published),  projection  upon 
one  side  or  the  other,  and  sometimes  upon  both  sides,  due  to 
fracture  or  excessive  development  of  bones  that  they  are 
always  located  between — the  turbinated  bones.  They  are  not 
always  just  in  the  center,  but  they  are  not  far  from  it.  I 
believe  these  are  also  the  result  of  stimulation  by  exhalation 
or  aspiration  of  air,  producing  a  healthy  physiological  action 
at  that  point. 

When  a  slight  irritation  of  the  mucous  membrane  takes 
place,  as  a  result  of  cold,  it  thickens.  The  child  experiences 
difficulty  in  breathing.  In  the  spasmodic  effort  to  draw  air 
into  the  lungs  through  the  nose  a  vacuum  is  formed  and  the 
septum  is  developed  and  drawn  to  the  point  of  least  resistance, 
which  would  naturally  be  at  a  point  between  the  turbinated 
bones.  In  this  manner  the  septum  takes  the  outline  midway 
between  the  bones.  The  fracture  very  rarely  extends  through 
the  two  halves  of  bone;  only  one  side  breaking,  while  the 
other  is  simply  bent.  The  fractured  half  being  always  upon 
the  convex  side  leads  the  author  to  believe  that  it  is  due  to  (1) 
the  thickening  of  the  mucous  membrane,  (2)  accumulation  of 
moisture  or  purulent  mucus,  and  (3)  an  excessive  effort  on  the 
part  of  the  patient  to  draw  air  through  the  nose.  This  being 
impossible  the  vomer  is  drawn  into  the  space  after  partial 
ossification  has  taken  place,  and,  as  a  result,  fracture  of  that 
half  and  simple  bending  of  the  other  half.  The  edges  of  the 
broken  half  are  torn  apart  from  the  other  half,  producing  a 
space  between,  which  is  eventually  filled  up  with  bone  cells. 
This  condition  is  not  unlike  the  fracture  of  a  green  stick. 
Sometimes  it  will  be  drawn  to  the  right  side  in  one  place  and 
to  the  left  in  another.  Again,  in  the  same  manner,  the  two 
lateral  halves  are  separated  their  entire  length,  as  illustrated 
in  Fig.  72.  Please  note  that  there  is  a  projection  of  the 
right  half  at  a  point  midway  between  the  right  turbinated 


276,  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

bones.  This  seems  to  the  author  to  be  the  only  natural  thing, 
since,  in  many  cases,  the  detiection  and  fracture  only  extends 
a  short  distance  in  the  anterior  middle,  or  posterior  part  of 
the  vomer,  while  the  bone  will  be  perfectly  straight  anterior 
and  posterior  to  the  deformity.  The  shape  of  the  deflection 
and  fracture,  it  seems  to  me,  can  be  accounted  for  in  no  other 
way.  In  order  that  fracture  may  take  place,  the  vomer  must 
have  ossified  partially  or  completely,  which  occurs  at  middle 
life;  therefore  injuries  ^?^  utero  or  subsequently,  before  ossi- 
tication,  are  out  of  the  question.  If  the  turbinated  bones  are 
uniformly  developed  the  vomer  will,  in  most  cases,  remain 
quite  or  nearly  straight.  The  force  produced  by  drawing  air 
will  frequently  separate  the  two  halves  and,  occasionally,  pro- 
duce one  fracture  upon  one  side,  the  other  upon  the  other 
side.  Not  only  are  the  cartilages  of  the  nose  brought  in  close 
relation  to  each  other,  but,  occasionally,  the  force  is  so  great 
that  there  is  a  total  collapse  of  the  outer  bony  walls  and  they 
are  drawn  toward  the  septum,  making  a  groove  upon  either 
side,  the  nasal  bones  remaining  perfectly  flat  at  the  upper 
edge. 

In  this  way,  by  taking  a  general  view  of  the  cavities  and 
the  nasal  bones,  we  find  a  uniform  distribution  throughout 
the  nasal  cavity. 

Under  such  conditions  the  specialist  should  be  exceedingly 
careful  in  regard  to  operations  for  the  removal  of  excessive 
growths  in  the  nose. 

The  conclusions  here  reached  may  be  stated  as  follows: 
The  deviation  of  the  nasal  septum  to  one  side  or  the  other  is 
the  result  of  an  unequal  development  of  adjacent  bony  parts, 
more  especially  and  directly  of  that  of  the  turbinated  bones. 
It  depends  largely,  if  not  exclusively,  upon  the  development 
and  position  of  these  latter.  They,  in  turn,  are  dependent  in 
great  measure  upon  the  development  of  the  facial  bones, 
which  are  modified  as  the  facial  angle  increases  and  progna- 
thism is  lost.  The  turbinated  bones  being,  as  it  were,  exostosed, 
not  molded  in  many  directions  b}'  adjacent  parts,  encroaching 
more  irregularly  upon  the  nasal  cavity,  as  their  origins  are 
disturbed  or  dislocated.     The  freedom  of  these  nasal  passages 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


277 


for  the  the  transit  of  respired  air  is  essential,  and  the  tendency 
of  normal  respiration  is  for  both  nostrils  to  share  equally  in 
this  function.  The  natural  consequence  of  this  is  that  the 
vomer,  the  ossification  of  which  is  incomplete  until  puberty, 
is  deflected  and  occupies  as  nearly  as  possible,  as  a  rule,  a 
midway  position  between  the  bony  prominences  on  either 
side.  The  deflection  of  the  septum  is  therefore  a  compensa- 
tory arrangement  for  the  evolutionary  imperfections  of  the 
facial  development — it  is  an  incident  of  evolution.     We  find 


Fig.  85. 


it  therefore  most  frequent  in  the  higher  races,  while  in  the 
ancient  Indians  of  this  country  and  the  negroes  and  others,  as 
observed  by  Allen,  others  and  myself,  the  percentage  of  its 
occurrence  is  markedly  decreased. 

Instability  of  tissue-building  is  to  be  expected  in  neurotics 
and  degenerates.  It  is  easy  to  see  how  with  such  an  unstable 
bone  tissue  to  build  upon  the  mucous  membrane  of  the  nose 
can  take  on  atrophy,  hypertrophy  and  adenoid  growths, 
resulting  in  mouth-breathing. 

It  seems  to  be  the  accepted  opinion  of  physicians  at  the 


2T8 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


present  time  that  consumption  is  not  an  inherited  disease, 
but  that  the  patient  inherits  or  acquires  a  weak  constitution, 
and  at  certain  periods,  when  the  system  is  in  proper  con- 
dition, the  bacilli  find  a  habitat  in  the  lungs  and  disease 
results. 

The  human  mouth  is  known  to  contain  bacteria  of  almost 
every  variety,  and  the  author  has  taught  students  for  the  past 
ten  years  that  it  was  his  opinion  that  the  mouth  becomes  the 
nidus  for  the  accumulation  of  germs,  and  that  when  the  sys- 


Fig.  66. 

tem  becomes  in  the  proper  condition,  these  germs  bring  on 
not  only  tuberculosis,  but  pneumonia  and  affections  of  the 
throat,  including  lesions  ranging  all  the  way  from  simple  sore 
throat  to  the  most  malignant  form  of  diphtheria,  and  it  seems 
to  the  author  that  these  conditions  may  be  avoided,  to  a  cer- 
tain extent,  by  keeping  the  mouth  in  a  healthy  condition. 
Persons  who  are  susceptible  to  these  diseases,  but  more  par- 
ticularl}^  consumption,  are  those  who  have  inherited  weak 
constitutions,  such  as  neurotics  and  degenerates.  Somatic 
signs  are  quite  noticeable  in  most  of  these  cases,  and  by  early 
recognition,  proper  treatment  with  change  of  climate  will,  in 


THE     HEAD,    FACE,    JAWS    AND    TEETH 


279 


most  cases,  prolong  life  for  many  years.  These  signs  have 
already  been  spoken  of  indirectly,  but  as  they  have  a  direct 
bearing  upon  deformity  of  the  nose,  it  will  not  be  out  of  place 
to  call  the  attention  of  the  reader  to  some  of  the  deformities, 
and  one  that  plays  an  important  part  in  the  welfare  of  the 
patient:  Total  collapse  of  the  outer  walls  of  the  nose  is  fre- 
quently observed  among  neurotics  and  degenerates.  This  is 
associated  with  arrest  of  development  of  the  bones  of  the  face, 
jaws,  deformities  of  the  dental  arch,  weak,  contracted  chest, 


Fig.  87 


round  shoulders,  husky  voice,  etc.  In  most  cases  of  this 
description  the  nose  is  very  long  and  thin.  The  nasal  bones 
are  excessively  developed  or  arrested,  with  marked  deflection 
of  the  septum.  Frequently  some  one  of  the  different  forms 
of  nasal  catarrh  are  present.  When  the  patient  attempts  to 
inhale  air  the  outer  walls  are  brouoht  tog-ether  and  nose- 
breathing  is  impossible.  The  result  is  mouth-breathing,  not 
only  taking  cold  air  into  the  lungs,  but  also  diseased  germs. 
The  preceding  illustrations  (Figs.  85,  S6,  87  and  88)  are  those 
of  persons  who  possess  all  of  the  signs  herein  enumerated. 


280 


ETIOLOGV   OF   OSSEOUS   DEFORMITIES 


These  pictures  are  front  views  of  those  used  in  the  chapter 
upon  deformities  of  the  face,  and  are  intended  to  illustrate 
the  long,  slender  nose.  By  comparing  these  with  those  repre- 
senting the  side  view,  a  very  good  idea  of  the  thinness  may 
be  obtained.  Three  of  these  persons  are  now  infected  with 
tuberculous  deposits,  and  the  fourth  will  require  the  best  of 
care  to  prevent  infection.  It  is  possible  for  persons  to  con- 
tract tuberculosis  who  do  not  present  stigmata,  but  it  is  the 
experience  of  the  writer  that  parents  who  have  children 
possessing  the  somatic  conditions  noted  in  this  chapter  should 


Fig.  88. 

pay  particular  attention  to  their  early  hygienic  welfare  in 
this  reofard. 


CHAPTER  XXV. 

NEUROSES  OF  DEVELOPMENT  OF  THE  ANTRUM. 

To  describe  the  antrum  is  one  of  the  most  difficult  tasks 
which  the  author  has  ever  undertaken.  He  has  examined 
many  skulls  with  this  idea  in  view;  but  he  has  found  that  a 
description  of  one  would  not  answer  for  another.  Indeed, 
no  two  could  be  found  to  correspond,  and  their  location,  as 
will  be  observed,  is  not  a  certainty.  The  length,  height, 
width  and  location  of  the  antrum  is  governed  entirely  by  the 
shape  of  the  face  and  by  the  bones  of  the  nose  and  of  the 
superior  maxillae,  thus  different  nationalities  would  possess 
antra  of  different  sizes  and  shapes.  They  seem  to  assume  the 
greatest  variation  even  in  normal  individuals,  while  stigmata 
of  degeneracy  are  not  only  marked  upon  the  external  but  also 
upon  the  internal  surface,  in  neurotics  and  degenerates.  We 
cannot  say,  however,  that  a  large  maxilla  will  contain  a  large 
antrum  or  a  small  maxilla  a  small  antrum;  many  things  will 
have  to  be  taken  into  consideration.  Indeed,  it  would  be 
impossible  by  looking  at  a  person  to  outline  the  position  of 
the  cavity.  Gray  says:  "The  antrum  is  a  large,  triangular- 
shaped  cavity;  its  apex,  directed  outward,  is  formed  by  the 
malar  process;  its  base  by  the  outer  wall  of  the  nose.  The 
author  has  examined  skulls  where  the  base  of  the  triangle  and 
apex  were  just  the  opposite.  Indeed,  from  the  author's 
experience,  he  would  very  much  doubt  the  propriety  of  call- 
ing the  shape  of  the  antrum  a  triangle.  He  has  observed 
antra  almost  square,  with  rounded  corners;  others  that 
would  be  very  difficult  to  describe  owing  to  the  many  deform- 
ities which  they  assume.  Septa  and  bulging  here  and  there 
with  corresponding  depressions  would  preclude  any  such 
description.  We  occasionally  find  the  outer  wall  of  the  nose 
bending  into  the  antrum,  tilling  25  to  33  per  cent  of  its  space. 
Occasionally,  the  outer  walls  of  the  antrum  will  be  very  thin; 
in  such  cases  the  antrum  will  be  large  and  well  formed,  but 
when  thick,  we   usually  find   Ihe  antrum  small  and  badly 

281 


2S2  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

deformed.  If  the  orbits  arc  not  evenly  located  (which  is  very 
common)  the  vault  of  the  antrum  will  be  higher  upon  one  side 
than  upon  the  other.  Sometimes  the  contour  of  the  orbit 
will  be  changed  so  that  in  one  antrum  the  outer  wall  will  be 
the  highest,  and  again  the  inner  wall  in  another.  This,  how- 
ever, will  depend  to  a  great  extent  upon  the  general  construc- 
tion of  the  osseous  structure. 

Occasionally  we  will  find  the  nasal  cavities  so  large  that 
they  will  extend  nearly  or  quite  to  the  outer  alveolar  borders. 
Again,  the  antrum  will  not  be  larger  than  the  end  of  the 
little  finger  and  will  be  located  in  the  malar  process. 

In  cases  of  stigmata  of  degeneracy,  as  illustrated  in 
"  Arrest  of  Development  of  the  Bones  of  the  Face  and  Jaw," 
we  would  expect  to  find  diflferent  shapes  and  positions  of  the 
antrum.  Thus,  in  one  case,  the  cavity  was  very  small  and 
resembled  a  crescent,  with  its  concavity  toward  the  nasal 
wall,  its  convexity  toward  the  malar  process.  It  was  not 
large  enouffh  to  admit  the  end  of  the  little  finger.  In  this 
case  it  did  not  extend  as  far  laterally  as  the  inferior  orbital 
opening.  The  opposite  side  was  similar  in  shape  and 
extended  just  beyond  this  opening.  Sometimes  the  antrum 
upon  one  side  will  be  very  long,  while  that  of  the  other  is 
very  small;  usually  the  nasal  cavity  will  be  carried  over 
nearly  one-half  of  its  size  to  the  side  of  the  smallest  antrum. 
We  sometimes  find  soft,  cancellated  bone  extending  the 
alveolar  process  into  and  filling  the  antrum,  leaving  a  num- 
ber of  small  openings  or  sinuses  which  resemble  the  ethnoidal 
cells.  In  these  cases  the  contour  of  the  face  is  also  very 
much  disfigured;  a  drill  passed  through  the  alveoli  of  the  first 
and  second  bicuspids  would  not  reach  an  opening. 

Bosworth  says,  on  page  75,  in  reference  to  the  develop- 
ment of  the  antrum  (Fig.  89):  "Or  again,  deficient  absorp- 
tion of  the  alveolar  process  in  fcetal  life  may  produce  marked 
encroachment  upon  the  lower  portion  of  the  cavity.  On  the 
other  hand,  the  cavity  may  be  abnormally  enlarged  from 
excessive  aljsorption  of  osseous  tissue  in  foetal  life  down- 
ward into  the  alveolar  process  or  forward,  as  the  result  of 
which  the  antrum  may  extend  between  the  floor  of  the  nose 


THE  HEAD,  FACE,  JAWS  AND  TE?:TH 


i^83 


and  the  hard  palate,  as  seen  in  Fig.  90,  or  it  may  extend  up 
into  the  malar  bone  or  into  the  frontal,  as  the  result  of  a 
similar  process  of  absorption  in  this  direction." 

As  the  alveolar  process  is  never  developed  in  foital  life,  nor 
to  the  extent  as  represented  here,  until  all  the  permanent  teeth 
are  in  place,  which  would  be  at  about  the  tenth  to  the  twelfth 
year,  absorption  could  not  take  the  place  of  something  that  did 
not  exist.  Again,  there  is  not  room  for  the  development  of 
the  first  and  second  set  of  teeth. 

This  drawing  (Fig.  89)  illustrates  a  jaw  and  nasal  bone  of 
a  person,  certainly  in  later  life,  after  all  the  teeth  had  been 
removed  and  absorption  of  the  external  surface  of  the  alve- 


Fig.  89. 

olar  process  had  been  going  on  for  many  years.  The  round- 
ness of  the  alveolar  process,  the  ridge  of  bone  in  the  vault 
and  the  vault  itself,  indicate  this  to  be  the  case.  An  alveolar 
process  the  size  and  shape  illustrated  here  could  only  develop 
with  the  second  set  of  teeth.  It  will  be  observed  that  the 
left  antrum  is  unusually  large;  that  it  extends  up  to  and 
encroaches  upon  the  left  orbital  cavity  and  quite  a  distance 
along  the  inner  border.  It  also  encroaches  upon  the  left 
nasal  cavity  and  downward  into  the  alveolar  process.  The 
right  antrum  is  very  small,  as  a  result  of  which  the  alveolar 
process  is  very  large  and  extends  quite  a  distance  into  the  floor 
of  the  nose.     To  compensate  for  this  want  of  harmony  in  the 


284 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


development  of  the  antrum,  the  turbinated  bones  have  become 
enlarged,  and  although  the  nasal  cavities  have  developed  con- 
siderably to  the  right  of  the  face,  all  the  bones  of  the  nose 
have  so  arranged  themselves  that  there  are  uniform  spaces 
between  them.  If  the  teeth  in  this  individual  remain  the 
usual  number  of  years  (this  drawing  represents  a  person 
from  fortv-live  to  sixty-five  years  of  age)  the  only  absorption 
that  could  possibly  take  place  would  be  at  the  outer  border  of 
the  alveoli. 

Fig.  90  not  only  shows  the  antra  extending  toward  the 
median  line  upon  both  sides,  encroaching  upon  the  nasal 
cavity,  but  there  are  also  ridges  of  bone  and  septa  extend- 


Fig.  90. 


ing  through  the  cavity.  This  is  likewise  the  case  in  Fig.  89. 
To  say  that  absorption  of  tissue  can  take  place  and  produce 
these  large  and  abnormal  cavities  encroaching  upon  other 
cavities,  developing  these  to  one  side,  does  not,  with  our 
knowledge  of  absorption  and  deposition  of  bone,  account  for 
these  conditions.  That  the  building  up  of  abnormal  tissues 
went  on  at  the  time  of  the  original  formation  and  shaping  of 
these  cavities  there  can  be  no  question,  and  until  a  better 
reason  is  given  it  must  be  said  that  it  is  due  to  a  want  of 
balance  in  nerve  function,  which  presides  over  development, 
or  they  are  stigmata  of  degeneracy. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  285 

The  following  cases  are  given  to  show  the  different  shapes 
and  locations  of  the  antrum: 

Case  I. — Is  that  of  a  prostitute.  Width  of  dental  arch, 
2.25.  The  antrum  upon  the  right  side  extends  back  as  far  as 
the  third  molar,  forward  to  the  canine  eminence;  from  the 
lower  border  of  the  alveolar  process  to  the  floor  of  the  orbit, 
the  cavity  was  triangular  in  shape;  the  apex  being  downward 
at  the  alveolar  process;  the  base  being  the  floor  of  the  orbit. 
Its  length  at  the  lower  part  was  1.50;  at  the  upper,  1.75; 
height  at  the  posterior  part,  1.75;  anterior  part,  1.50; 
width  below,  .25;  at  the  upper,  .62  of  an  inch.  The  cavity 
was  divided  into  two  separate  parts  by  a  septum  of  bone  .50 
of  an  inch  in  height;  another  septum  of  bone  extended 
horizontally  along  the  inner  side  opposite  the  inferior  orbital 
ridge.  The  left  side  of  the  superior  maxilla  was  very  much 
arrested  in  its  development,  with  a  marked  protrusion  of  the 
alveolar  process  and  teeth  to  make  a  respectable  dental  arch 
to  correspond  to  that  of  the  other  side.  The  antrum  extended 
from  the  third  molar  forward  to  the  second  bicuspid.  The 
length  of  the  antrum  at  its  lowest  part  measured  1;  upper 
part,  1.50;  height  at  the  anterior  part,  1.21;  at  the  posterior 
part,  1.60;  width  at  lower  border,  .36;  at  upper  border,  .50. 
The  apex  in  this  case  was  located  at  the  malar  process,  its 
base  being  the  outer  wall  of  the  nose.  A  drill  passed  into 
the  cavity  of  the  flrst  bicuspid  upon  the  right  side  would 
penetrate  only  one-half  of  the  antrum,  while  it  would  require 
an  opening  at  the  second  molar  to  drain  the  posterior  cavity. 
In  either  case  the  drill  would  have  to  travel  only  about  .25 
an  inch  from  its  outer  border.  If  a  drill  were  carried  into 
the  antrum  at  the  anterior  root  of  the  first  permanent  molar 
upon  the  left  side,  it  would  have  to  pass  .75  of  an  inch  to 
reach  it. 

Case  II. — Is  that  of  an  Irishman,  a  degenerate  and  epi- 
leptic. Width  of  dental  arch,  2.75;  vault  is  .84  in  height; 
jaws  are  very  large  and  massive.  The  antrum  upon  the 
right  side  extends  from  the  posterior  surface  of  the  third 
molar  forward  at  lower  border  to  the  anterior  root  of  the  first 
permanent  molar;  at  the  upper  border,  on  a  line  with  canine 


286  ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 

eminence.  Over  the  root  of  the  second  bicuspid  there  is  a  ver}' 
marked  depression,  showing  that  the  walls  of  the  antrum 
unite  at  that  point.  The  cavity  is  almost  square,  as  Avill  be 
seen  by  the  figure;  length  of  lower  border,  1.12  of  an  inch; 
upper  border,  1.52  of  an  inch;  height  of  anterior  part,  1,25; 
posterior,  1.20;  width  below,  .75;  above,  .80.  To  reach  the 
antrum  at  the  second  bicuspid  the  drill  w^ould  have  to  travel 
1.25  from  the  lower  border  of  the  alveolar  process;  at  the 
anterior  root  of  the  first  molar,  .75  from  lower  border.  The 
antrum  upon  the  left  side  extended  .  50  of  an  inch  back  of  the 
second  molar  (the  third  molar  not  being  present)  forward  to 
a  point  over  the  root  of  the  second  bicuspid;  the  upper  part 
extended  as  far  as  the  canine  eminence.  Length  at  lower 
border,  1.25;  upper,  1.75;  height  anterior,  .7;  posterior, 
1.25;  width,  .75;  lower  border,  .78;  upper  border,  .80.  To 
reach  the  antrum  at  second  bicuspid  the  drill  would  have  to 
pass  1,  with  difficulty  in  reaching  it;  at  anterior  root  of  first 
molar,  .84.     Both  cavities  are  free  from  septa. 

Case  III. — Is  that  of  a  criminal.  The  third  molar  was 
never  present  upon  the  right  side.  The  antrum,  therefore, 
extended  .50  beyond  the  second  molar  forward  as  far  as  the 
anterior  root  of  the  first  permanent  molar,  on  the  upper  bor- 
der to  a  point  above  the  canine  eminence.  This  cavity  pos- 
sesses a  very  peculiar  shape,  as  will  be  noticed  in  the  figure. 
Length  of  the  lower  border,  1;  upper,  1.50;  height  anterior, 
1;  posterior,  1.25;  width  lower,  .50;  upper,  .84;  triangular 
in  difl'erent  directions.  First  apex  at  outer  surface  of  malar 
bone;  base  outer  plate  of  the  nose;  second  apex  anterior  near 
the  nose,  and  base  toward  posterior  surface.  The  roots  of  the 
first  and  second  molars  penetrate  the  antrum  as  in  drawing. 
The  antrum  could  only  be  reached  by  going  through  the 
outer  plate  of  the  alveolar  process  at  the  first  permanent  molar. 
The  antrum  upon  the  left  side  extended  from  the  posterior 
surface  of  the  second  molar  forward  to  the  first  permanent 
molar.  Length  of  lower  border,  1.25;  upper,  1.75;  height 
anterior,  .75;  posterior,  1.25;  width  lower,  .50;  upper,  .60. 
This  was  a  very  remarkable  cavity.  The  roots  of  the 
second  and  third  molars  penetrated  the  floor  of  the  cavity;  an 


THE    HEAD,    FACE.    JAWS    AND   TEETH  l{87 

abscess  had  appeared  upon  the  buccal  roots  of  the  first  molar, 
without  injury  to  the  floor  of  the  antrum.  The  outer  wall  of 
the  nose  had  bulged  into  the  antrum  its  entire  length  and 
width  from  the  lower  turbinated  bone  to  the  floor  of  the  nose. 
The  inner  and  outer  walls  of  the  antrum  had  become  united 
at  about  its  middle  by  a  septum,  making  two  distinct 
cavities. 

Case  IV. — Is  that  of  a  pauper.  The  antrum  upon  the 
right  side  extended  .50  of  an  inch  beyond  the  third  molar; 
forward  at  lower  border  as  far  as  the  second  bicuspid;  at 
upper  border  to  a  point  over  the  canine  eminence.  The  apex 
of  the  triangle  in  this  case  is  located  at  the  junction  of  the 
wall  of  the  nose  and  floor  of  the  orbits.  The  base  was  formed 
by  the  outer  surface,  the  malar  process;  a  ridge,  dividing  the 
anterior  part  of  the  antrum  into  two  cavities,  extends  from  the 
floor  of  the  orbit  down  about  half  the  depth  of  the  antrum  at 
a  point  of  exit  of  the  inferior  orbital  nerve  and  artery.  The 
outer  wall  of  the  nose  curves  into  the  antrum,  filling  it  about 
one-third  full.  It  will  be  seen,  therefore,  that  the  cavity  is 
very  irregular  in  shape.  Its  length  at  the  lower  border  is 
1.12;  upper  border,  1.38;  height,  anterior  part,  .75;  pos- 
terior, 1.25;  width  lower  border,  .36;  upper,  1  inch.  The 
molar  teeth  extend  into  the  floor  of  the  cavity.  Arrest 
of  development  of  the  maxillary  bone  upon  the  left  side 
necessarily  causes  the  antrum  to  be  much  smaller  than  upon 
the  right  side.  Like  the  right  antrum  it  extends  .60  of  an 
inch  beyond  the  molar;  its  lower  border  extends  forward  to 
the  anterior  root  of  the  first  permanent  molar,  its  upper  bor- 
der to  a  point  over  the  cuspid  tootK.  Length  of  lower  border, 
1;  upper,  1.25;  height  anterior,  .75;  posterior,  1.12;  width 
lower  edge,  .25;  upper,  .92.  The  palatine  roots  of  the  first 
and  second  molars  penetrate  the  floor  of  the  antrum. 

Case  V. — Is  that  of  a  prostitute.  The  right  antrum  is 
very  small  and  extends  back  to  the  posterior  surface  of  the 
second  molar,  the  third  molar  not  being  present.  From  the 
lower  border  of  the  antrum  to  the  lower  border  of  the  alveolar 
process  is  .  75  of  an  inch ;  the  roots  of  the  teeth  therefore  do 
not  reach  within  .25  of  the  floor  of  the  cavity.     The  length 


288  KTIOLOOY  OF  OSSEOUS  DEFORMITIES   OF 

of  the  lower  border  is.75;  upper,  1.12;  height  of  the  antrum, 
.(iO;  posterior,  1;  width  of  lower,  .25;  upper,  1.  A  sep- 
tum extends  the  entire  length  of  the  outer  and  inner 
walls,  except  a  space  about  the  size  of  a  lead-pencil,  dividing 
the  antrum  into  almost  two  distinct  cavities.  The  left  antrum 
extends  to  the  posterior  border  of  the  third  molar;  the  cavity 
is  slightly  larger  than  the  other,  although  the  alveolar  pro- 
cess is  just  as  large,  and  therefore,  the  anterior  border,  so  far 
as  the  teeth  are  concerned,  has  no  relation  to  this.  The  length 
of  loAver  border,  .86;  of  the  upper,  1.22;  height  of  antrum, 
posterior,  .62;  anterior,  1;  width,  .28;  upper,  1.02.  This 
cavity  contains  a  number  of  septa  running  in  every  direction. 
The  nasal  bone  bends  inward,  and  in  every  way  shows  stig- 
mata of  degeneracy.  If  a  drill  were  to  carried  into  the  antrum 
through  the  roots  of  the  bicuspids  it  would  have  to  travel  .60 
of  an  inch,  and  then  would  not  reach  the  lowest  point.  We 
are  not  warranted  in  making  openings  into  the  antrum  through 
the  root  canals  of  the  molars,  because  they  rarely  incline  in 
that  direction.  The  drill  would  pass  either  into  the  floor  of 
the  nose  or  out  at  the  cheek. 

The  following  illustrations,  here  referred  to,  show  stig- 
mata of  the  antra  and  the  difficulty  of  always  reaching  the 
tioor  of  the  antrum  by  passing  a  drill  up  through  the  alve- 
olus for  the  purpose  of  drainage.  Fig.  77  illustrates  the  left 
antrum  excessively  developed.  The  base  of  the  cavity  located 
at  the  floor  of  the  orbit,  the  apex  near  the  borders  of  the 
alveolar  process,  extends  quite  a  distance  toward  the  median 
line  and  under  the  nasal  cavity.  It  even  encroaches  upon  the 
left  nasal  cavity  at  its  upper  border.  A  drill  would  pass 
without  trouble  into  this  cavity  through  the  palatine  or  even 
buccal  roots  of  any  of  the  molar  teeth.  Quite  a  difierent  state 
of  things  is  noticed  upon  the  right  side.  The  nasal  cavity  is 
carried  over  and  occupies  the  space  where  the  antrum  should 
be  located.  The  antrum  is  very  small  upon  the  inner  surface 
of  the  malar  process  under  the  eye.  A  drill  passed  through 
the  alveolus  would  certainly  enter  the  floor  of  the  orbit. Fig.  78 
also  shows  both  antra  located  in  such  a  position  that  the 
drill  passing  through  the  alveoli  would  not  penetrate,  but  in 


THE     HEAD,    FACE,    JAWS    AND   TEETH  289 

both  cases  the  floors  of  the  nasal  cavities  would  be  punctured. 
The  left  antrum  in  Fig.  79  is  almost  entirely  ol>literated. 
Stigmata  are  not  only  seen  in  the  antra,  but  also  throughout 
the  nasal  bones  and  ethmoidal  cells. 

It  is  possible  to  reach  both  antra  by  drilling  through  the 
alveoli,  but  it  could  not  be  accomplished  without  difficulty. 
The  cross  section  of  Fig.  80  was  taken  so  far  forward  that  a 
description  of  the  antra  is  out  of  the  question. 

Fig.  81  shows  the  antra  so  small  as  to  be  almost  obliter- 
ated. The  nasal  cavities,  however,  are  so  large  that  the 
floors  of  these  cavities  would  be  punctured  if  a  drill  was 
passed  through  the  alveoli. 

Some  years  ago  I  recorded  a  case  where  a  patient,  in 
having  an  opening  drilled  through  the  cavity  of  the  second 
bicuspid  to  relieve  the  antrum,  the  drill  passed  into  the  floor 
of  the  nose.  At  that  time  it  occurred  to  me  that  there  was 
gross  ignorance  on  the  part  of  the  operator  as  to  the  location 
of  the  antrum.  My  attention  has  since  been  called  to  several 
cases  by  specialists. 

In  my  examination  of  skulls  for  the  purpose  of  preparing 
this  chapter,  I  have  discovered  some  seven  or  eight  cases 
where  the  floor  of  the  nose  was  so  wide  and  the  facial  bones 
so  deformed  that  the  long  axis  of  the  roots  were  directed  into 
the  floor  of  the  nose.  In  each  case  the  floor  of  the  nose  would 
be  perforated  were  the  operator  to  drill  through  the  palatine 
buccal  roots  of  the  first  or  second  molars.  Again,  I  have 
frequently  observed  arrest  of  development  of  the  maxillary 
bone  on  a  line  with  the  alae  of  the  nose,  when  the  alveolar 
process  (in  order  that  the  teeth  might  antagonize  with  the 
lower  teeth)  extended  outward  to  such  an  extent  that  the 
apices  of  the  roots  of  the  bicuspids  would  point  entirely  out- 
side of  the  line  of  the  antrum.  It  will  be  seen,  therefore, 
that  the  alveoli  are  not  a  reliable  route  by  which  to  reach  the 
lowest  point  in  the  floor  of  the  antrum,  nor  is  the  operator 
sure  of  reaching  it  at  all.  It  is  easy  to  see  how  in  a  very  few 
cases  the  development  of  the  antrum  and  nasal  cavities  might 
be  so  arranged,  together  with  the  thinness  of  the  alveolar 
process,  that  the  roots  of  the  teeth  may  penetrate  the  floor 


290 


ETIOLOGY   OF  OSSEOUS  DEFORMITIES    OF 


of  the  cantrum,  as  illustrated  in  Fis:.  91.  These  cases,  how- 
ever, are  very  rare,  as  we  shall  see  later.  Again,  we  can 
also  observe  how  in  most  cases,  owing  to  the  thickness  of  the 
alveolar  walls  and  the  position  of  the  antrum,  the  roots  of  the 
teeth  will  not  reach  it.  As  will  be  noticed  it  is  very  rarely 
and  almost  never  the  case  that  the  roots  of  the  first  and  second 
bicuspids  enter  the  floor  of  the  antrum.  The  roots  of  the  first 
permanent  molar  in  its  relation  to  the  antrum  are  such  that 
it  is  almost  impossible  to  penetrate  them. 

Of  the  11,000  skulls  examined  for  deformities  only  3,000 


Fig.  91. 


were  in  a  broken  condition,  so  that  the  antra  could  be  exam- 
ined, making  6,000  antra  in  all.  Of  this  number  1,274:,  or 
about  21  per  cent,  had  abscessed  molar  teeth.  Of  this  num- 
ber 76,  or  about  6  per  cent,  extended  into  and  apparently 
discharged  into  the  antrum.  Taking  into  consideration  the 
fact  that  specialists  were  unknown  among  the  people  whose 
skulls  were  examined,  we  would  expect  to  find  a  larger  per- 
centage of  abscessed  cavities  than  at  the  present  day,  which 
has  been  shown  by  the  examination  of  both  skulls  and  patients. 
Septa  were  found  in  963  cases.  These  ranged  all  the  way 
from  a  simple  ridge  running  along  the  floor  to  a  partition 
extending  two-thirds  the  height  of  the  cavity.  Again,  several 


THE    HEAD,    FACE,    JAWS    AND   TEETH  291 

septa  occurred  in  all  directions,  which  gave  the  appearance  of 
of  ethmoidal  cells  extending  throughout  the  entire  cavity. 

In  the  treatment  of  367  cases  of  pulpless  teeth,  in  connec- 
tion with  the  superior  molars,  in  the  past  twenty-two  years, 
only  three  cases  of  diseased  antrum  were  noticed,  making 
less  than  three  per  cent  of  diseased  antrum. 

Dr.  M.  H.  Fletcher  found  in  224  cases  of  pulpless  molar 
teeth,  treated  by  him,  only  one  case  of  pus  in  the  antrum. 
These  statements,  therefore,  would  show  that  antral  difficul- 
ties are  very  rarely  connected  with  the  teeth.  The  author  is 
of  the  opinion  that  most  cases  of  diseased  antrum  seek  the 
specialist  because  most  cases  are  connected  with  the  nasal 
lesion,  and  therefore  the  dental  surgeon  sees  only  a  small 
percentage  of  actual  cases.  The  author,  therefore,  is  of  the 
opinion  that  disease  of  the  antrum  is  ver}'^  rarely  due  to  dis- 
eases of  the  teeth,  and  that  like  diseases  of  the  mucous  mem- 
brane of  the  nose;  the  mucous  membrane  of  the  antra  is  to 
a  great  extent  the  result  of ^irst,  a  very  abnormal  develop- 
ment of  the  osseous  system,  and,  second,  of  improper  tonicity 
of  the  nervous  system  acting  upon  a  badly  developed  mucous 
membrane. 

My  experience  has  been  that  disease  of  the  antrum  is 
most  often  observed  in  persons  who  have  been  exposed  to 
cold  weather,  and  that  both  sides  are  more  or  less  affected. 
This  was  a  common  occurrence  with  the  epidemic  of  la 
grippe.  If  only  one  side  is  involved,  the  other  frequently  is 
or  has  been  at  a  previous  time.  In  the  large  number  of 
skulls  examined,  the  floor  of  the  antrum  was  found  to  be  nearly 
on  a  level  with  the  line  of  the  alveolar  process  as  far  as  the 
anterior  roots  of  the  first  molar.  It  then  curves  upward  and 
forward,  terminating  at  a  point  above  the  apex  of  the  root  of 
the  cuspid  tooth.  That  being  the  case,  a  drill  passed  through 
the  alveoli  of  the  first  and  second  bicuspid  would  reach  a 
point  quite  a  distance  above  the  floor  of  the  antrum.  From 
what  has  been  said  in  regard  to  the  shape  and  location  of  the 
antrum,  it  will  be  seen  that  the  lowest  point,  and  always 
safest  locality  to  puncture  the  antrum,  is  at  a  location  just 
between  the  roots  of  the  first  permanent  molar  and  the  root 


292  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

of  the  second  bicuspid.  The  opening  should  be  made  with 
a  drill  directed  backward  and  inward.  This  part  is  nearly 
always  on  a  level  with  the  floor  of  the  antrum,  and  the  outer 
wall  is  very  thin  at  that  point.  The  patient  should  be 
requested  to  lie  first  upon  the  back  and  then  upon  the  face. 
Should  there  be  any  septa  the  fluid  will  in  this  way  be  easily 
drained. 

Since  this  was  written  Dr.  M.  H.  Fletcher,  of  Cincinnati, 
Ohio,  read  the  paper  "Some  Suggestions  as  to  the  Relation 
of  the  Teeth  to  Empyema  of  the  Maxillary  Sinus,"  before 
the  Section  on  Oral  and  Dental  Surgery  of  the  American 
Medical  Association,  held  in  Milwaukee,  Wisconsin,  June  1, 
1893.  I  consider  this  contribution  of  so  much  importance 
that  I  take  the  liberty  to  quote  his  results: 

"The  summing  up  or  rationale^  then,  of  the  evidence  here- 
with seems  to  he ^  firsts  that  the  anatomical  relations  between 
the  teeth  and  the  antrum  are  not  generally  understood,  since 
the  sections  here  shown  give  evidence  of  much  more  can- 
cellous bone  than  is  usually  considered  to  exist. 

"  Second.  Small  septa  are  present  in  a  large  per  cent  of 
cases,  and  these  septa  or  ridges  have  no  direct  relation  to  the 
position  of  the  teeth. 

' '  Third.  Statistics  seem  td  show^  that  a  very  small  per  cent 
of  abscessed  teeth  have  any  connection  whatever  with  the 
antrum;  this  per  cent  probably  not   being  over  seven  to  ten. 

' '  Fourth.  The  evidence  seems  to  indicate  that  the  protru- 
sion of  the  teeth  into  the  cavity  is  very  largely  the  exception 
instead  of  the  rule,  and  that  if  they  do  protrude,  it  is  not  evi- 
dence that  an  alveolar  abscess  would  break  there,  since  these 
tubercles  are  usually  formed  of  dense,  hard  bone. 

'■'■Fifth.  A  number  of  cases  have  been  found  where  there  is 
a  perforation  of  the  bone  by  the  apices  of  the  teeth  and  no 
protrusion;  but  that  these  apices  are  simply  covered  with 
mucous  membrane,  thereby  the  teeth  may  be  affected  by 
inflammation  of  the  antrum,  causing  their  death  and  loss  or 
a  continuance  of  the  trouble  in  the  antrum  by  their  presence 
in  consequence  of  this  special  feature  of  the  anatomy,  and 
that  pulpless  and  inflamed  teeth  are  thought  to  be  the  usual 


THE     HEAD,    FACE,    JAWS    AND   TEETH  293 

cause  of  antral  trouble,  where  the  reverse  is  often  probably 
the  case. 

''''Sixth.  That  seemingly  the  best  place  to  perforate  the 
antrum  of  Highmore  for  pus,  is  between  the  apices  of  the 
second  bicuspid  and  first  molar." 

It  will  therefore  be  observed  that  the  experience  and  con- 
clusion of  Dr.  Fletcher  are  not  unlike  my  own.  Nov.  9, 
1893, 1  received  the  following  letter  from  Dr.  Fletcher: 

"Since  writing  this  paper,  I  have  examined  an  addi- 
tional 400  skulls,  and  find  the  figures  changed  in  regard 
to  the  per  cent  of  abscessed  molars  which  are  connected 
with  the  antrum.  In  500  skulls  (making  1,000  antra)  I 
find  252  upper  molars  abscessed,  making  twenty  five  per 
cent  of  antra  which  have  abscesses  in  this  locality,  or 
every  fourth  antrum.  This  per  cent  is  probably  smaller 
than  it  should  be,  since  many  teeth  were  lost  and  the  alveolar 
process  absorbed  away,  and  undoubtedly  some  of  these  lost 
teeth  have  been  abscessed.  Out  of  these  252  possible  cases, 
perforation  into  the  antrum  was  found  only  twelve  times; 
thus  showing  over  four  and  one-half  per  cent,  or  about  one 
in  every  twenty-one  of  the  abscessed  teeth  in  this  locality, 
which  are  connected  with  the  antrum." 

The  extended  examinations  and  observations  made  by  Dr. 
Fletcher  and  the  author  present  similar  results. 


CHAPTER  XXVI. 

NEUROSES  OF  DEVELOPMENT  OF  THE  BONES  OF 
THE  ORBITS. 

In  the  development  of  the  osseous  system  the  orbital 
cavities  take  different  shapes  and  positions  in  neurotics  and 
degenerates.  Sometimes  they  are  placed  near  each  other, 
and,  again,  far  apart.  Thus,  in  a  measurement  of  2,600 
skulls,  from  the  junction  of  the  lachrymal  and  frontal  bones 
of  one  orbital  cavity  to  the  same  point  on  the  other,  the  near- 
est measurement  was  .84  of  an  inch,  and  the  greatest  width 
was  1.25,  thus  showing  that  the  sight  in  those  farther  apart 
possess  the  greatest  field  of  vision.  In  degenerates  especi- 
ally, the  orbital  cavities  deviate  from  a  horizontal  line.  In 
some  cases  the  lateral  halves  of  the  face  will  be  normal,  while 
one  orbit  will  be  located  higher  than  the  other.  This  is  illus- 
trated in  Fig.  64.  Again,  the  face  would  present  the  appear- 
ance of  having  been  made  in  two  halves  and  placed  together,  so 
that  one  half  would  be  higher  than  the  other.  The  author  has 
observed  quite  a  number  of  such  cases.  This  would  cause  the 
orbital  cavity  to  be  situated  higher  on  one  side  than  the  other. 
The  depth  of  the  orbits  also  varies  not  only  in  different  skulls, 
but  also  in  the  same  skull.  Thus  from  the  supra-orbital  notch 
to  the  optic  foramen  is  1.70  of  an  inch  to  1. 12  inches  in  different 
skulls,  and  from  .12  to  .18  of  an  inch  in  same  skull.  The 
shallowness  of  some  of  these  skulls  would  indicate  neuroses 
as  well  as  degeneracy. 

Dr.  G.  Frank  Lydston,  in  speaking  of  orbital  deformities, 
says:*  "This  is  well  shown  b}--  comparison  with  some  of  the 
other  types  already  described,  the  measurements  being  If 
inches  from  the  upper  margin  of  the  orbit  to  the  optic  fora- 
men, while  in  the  Indian  and  negro  skulls,  in  this  series,  the 
orbits  measure  two  inches  in  depth.  The  outer  walls  of  the 
orbits  encroach  upon  the  cavities,  giving  a  still  more  marked 

*  The  Alienist  and  Neurologist,  Oct.  1891. 

294 


THE     HEAD,    FACE,    JAWS   AND    TEETH  295 

appearance  of  shallowness.  The  form  and  index  of  the  orbit 
are  given  considerable  weight  by  anthropologists  as  a  crite- 
rion of  racial  type. 

"It  is  claimed  by  Dr.  Lydston,  and  verified  by  him 
by  comparative  studies  of  orbital  development,  that  the 
form  of  the  orbit  is  even  of  greater  importance  as  bear- 
ing upon  the  question  of  degeneracy  of  type.  That 
marked  variation  of  the  form  and  measurements  of  the  orbit 
is  incidental  to  differentiation,  is  seen  by  observation  of  the 
anthropoids.  There  is  a  striking  difference  between  the  mem- 
bers of  the  Simian  group  in  this  respect,  and  a  still  greater 
difference  is  noticeable  between  the  simiadce  and  lemuridm.'''' 
The  shallowness  and  obliquity  of  the  orbits  is  strikingly 
similar  to  the  characters  observed  in  the  gorilla  and  chim- 
panzee, which  are  quite  different  from  those  noted  in  the 
orangs.  The  outer  surface  of  the  orbits  not  only  differs  in 
shape  in  different  skulls,  but  they  also  differ  from  each  other 
in  the  same  skull.  Thus,  the  cavity  is  supposed  to  be  quad- 
rilateral in  shape.  The  angles,  however,  differ  in  degree; 
some  are  nearly  round,  others  square  with  round  corners; 
still  others  in  which  the  lower  outer  corner  extends  outward 
and  downward  quite  a  little  beyond  the  inner  corner.  The 
walls  of  the  inner  part  of  the  orbit  are  not  infrequently 
deformed  or  twisted  out  of  shape.  It  is  easy  to  see  how, 
when  the  maxillary  bones  and  antra,  the  ethmoidal  bones  and 
cells  (the  frontal  lobes  of  the  brain)  are  deformed,  the  walls 
of  the  orbit  will  correspond  to  these  deformities.  None  of 
the  special  organs  of  sense  are  so  liable  to  become  affected  in 
cases  of  neuroses  and  degeneracy  as  the  eyes,  and  these 
deformities  are  to  be  found  more  among  the  neurotics  and 
degenerates  than  any  other  class  of  individuals.  Quite  a 
difference  was  also  noticed  in  the  size,  shape  and  position  of 
the  optic  foramen  and  fissure.  These,  however,  were  not 
studied  with  sufficient  intention  to  give  scientific  descriptions 
of  their  different  positions  and  shapes.  The  author  will  only 
say  that  owing  to  stigmata  of  degeneracy  of  surrounding  parts 
it  would  be  natural  to  expect  abnormal  development  in  con- 
nection with  these  cavities. 


29t)  ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 

OCULAR   AFFECTIONS    ASCRIBABLE    TO   DEFORMITY   OF   THE 

ORBITS. 

That  orbital  deformities  have  a  causal  relation  to  certain 
ocular  aliections  cannot  be  well  denied.  Among  the  more 
frequent  conditions  arising  from  or  directly  traceable  to  inflam- 
mation of  the  orbits  may  be  mentioned  exophthalmus,  'or 
protrusion  of  the  eyeball  from  the  orbit;  slighter  degrees 
of  this  affection  are  only  perceptible  in  case  the  trouble  lies 
in  the  one  eye,  when,  by  comparison,  a  diagnosis  is  readily 
obtained.  In  higher  degrees  the  difference  is  quite  percept- 
ible even  to  the  casual  observer.  In  diagnosticating  this  con- 
dition, a  nice  point  to  remember  is  that  ordinarily  if  a  straight- 
edge be  applied  vertically  to  the  supra  and  infra-orbital 
margins  it  comes  in  contact  only  with  the  apex  of  the  cornea, 
but  does  not  compress  it.  The  two  chief  predisposing  fac- 
tors of  exophthalmus  are:  (1)  Increased  orbital  tissue;  (2) 
V/^  diminution  of  the  orbital  capacity;  both  of  which  conditions 
are  regulated  by  orbital  deformity  as  a  result  of  degeneracy. 
In  the  consideration  of  the  question  of  orbital  deformities  we 
must  not  lose  sight  of  the  fact  that  the  conformation  and  size 
of  the  orbit  keep  pace  with  the  enlargement  of  the  eyeball. 
Thus,  if  the  eyeball  is  retarded  in  growth  from  any  cause, 
or,  if  indeed,  enucleation  becomes  necessary  in  early  life,  the 
orbital  dimensions  are  necessarily  narrowed  and  contracted, 
so  that  if  it  becomes  requisite  in  later  life  to  adjust  an  arti- 
ficial eye,  we  find  it  impossible  to  insert  an  eye  approximating 
its  fellow  in  size.  Furthermore,  we  should  also  note  that  the 
position  of  the  eyeball  in  the  orbit  varies  in  different  individ- 
uals, and  that  there  may  be  a  difference  in  the  two  eyes  of  the 
same  individual;  this  being  associated  with  an  asymmetrical 
face,  which,  in  turn,  may  be  directly  traceable  to  degeneracy. 
These  conditions  usually  entail  a  difference  in  the  refraction 
of  the  eyes,  and  in  such  cases  the  exophthalmus  may  be  only 
apparent,  as  the  myopic  eye  is  usually  larger,  and,  therefore, 
might  simulate  an  exophthalmus. 

Another  ocular  affection  that  is  prone  to  ensue  as  a  result 
of  orbital  deformity  is  optic  neuritis,  which  probably  arises 


THE     HEAD,    FACE,    JAWS    AND   TEETH  297 

from  pressure  upon  the  nerve  at  the  site  of  the  optic 
foramen. 

Von  Graefe  was  the  first  to  point  out  this  fact,  and  since 
his  time  many  cures  have  been  recorded.  Nettleship  has 
recorded  cases  of  post-papillitic  atrophy  as  a  sequence  of 
congenital  hyperostosis. 

Among  other  frequent  ocular  malformations  consequent 
upon  degeneracy  may  be  mentioned  coloboma  iridis,  and, 
rarely,  coloboma  of  the  choroid,  lens  and  lids.  Coloboma  of 
the  iris  is  explicable  as  a  sequence  of  coloboma  of  the  choroid. 
Inasmuch  as  the  iris  projects  from  the  anterior  border  of  the 
choroid  at  a  time  when  the  foetal  ocular  fissure  is  closed,  it 
has  no  fissure;  but  if  the  choroid  experiences  abnormal  develop- 
ment at  the  retinal  fissure,  the  deformity  may  be  imparted  to 
the  iris,  and  the  latter  fails  to  develop  at  the  abnormal  area, 
and  is  lacking  at  'this  site,  constituting  coloboma  of  the  iris. 

Anophthalmus,  microphthalmus  and  buphthalmus  are 
likewise  conditions  that  are  seen  at  times  arising  from  orbital 
deformity.  The  results  of  degeneracy  implicating  the  ocular 
development  are  sometimes  peculiarly  striking.  Thus,  we 
have  retinitis  pigmentosa,  which  Leber  has  cited  as  persistent 
throughout  generations.  Congenital  aphakia,  or  total  absence 
of  both  lenses,  has  been  noted.  Typical  albinoism  with  con- 
genitally  displaced  lenses,  tremulous  irides,  etc.,  is  a  some- 
what frequent  result  of  degeneracy. 

Double  amiridia,  or  absence  of  both  irides,  has  been  like- 
wise noted,  as  well  as  cases  of  sclerectasia  poscterior.  The 
ocular  affections  which  are  most  typically  illustrative  of  the 
effects  of  degeneracy,  manifesting  itself  in  the  form  of  defects 
of  orbital  contour,  and  those  too  that  are  most  frequent,  may 
be  grouped  under  the  general  heading  of  refractive  errors, 
which  are  of  variable  degree  and  type.  Thus,  as  a  result  of  a 
contracted  eyeball  antero-posteriorly,  we  have  hyperopia,  a 
condition  of  the  refraction  in  which  parallel  rays  of  light 
impinging  upon  the  eye  are  not  focused  upon  the  retina,  but 
behind  the  same,  this  being  ordinarily  ascribable  to  an  axial 
defect.  Precisely  opposite  in  its  characters  is  the  short- 
sighted eye,  which  ordinarily  arises  from  an  elongated  antero- 


y 


298     .  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

posterior  axis,  which  causes  an  increased  refractivity  of  the 
eye  whereby  parallel  rays  are  focused  in  front  of  the  retina 
instead  of  upon  it,  as  they  are  in  the  emmetropic  or  normal 
eye.  Combinations  of  the  above  types  are  found  in  conjunc- 
tion with  the  normal  or  emmetropic  eye,  constituting  differ- 
ent types  of  astigmatism,  so  that  we  find  these  defects  as  a 
natural  consequence  of  degeneracy  entailing  orI)ital  deformity, 
and  while  we  recognize  that  degeneracy  is  not  necessarily  the 
rule  as  a  predisposing  canse  of  such  conditions  of  the  refrac- 
tion, yet  they  are  sufficiently  frequent  to  make  it  highly  sug- 
gestive. The  prevalence  of  such  a  large  number  of  young 
people  wearing  glasses  in  some  of  our  Eastern  cities  has  led 
to  the  common  remark  that  it  denoted  intellectual  ability. 
The  author  would  suggest  that  it  denotes  physical  defects 
often  due  to  neuroses  and  degeneracy. 

Perhaps  there  is  no  lesion  so  common,  as  the  result  of 
degeneracy  of  the  osseous  system  in  its  relation  to  the  eyes,  as 
stenosis  of  the  naso-lachrymal  duct.  Occasionally  only  one 
side  will  become  involved,  and  again  both  sides.  These 
cases  are  more  noticeable  where  there  is  arrest  of  develop- 
ment of  the  bones  of  the  face,  as  illustrated  in  Fig.  80.  In 
this  class  the  bridge  of  the  nose  is  undeveloped,  as  well  as  all 
the  other  bones  of  the  face  which  are  on  a  level  with  the  bridge 
of  the  nose,  the  result  of  which  is  one  or  both  canals  are  parti- 
ally or  nearly  undeveloped.  The  same  condition  is  frequently 
found  where  the  bridge  of  the  nose  is  very  narrow  and  high, 
as  illustrated  in  Fig.  70.  In  such  cases  degeneracy  of  the 
bones  of  the  face  is  even  more  noticeable  than  in  the  other 
cases.  The  results  of  such  deformities  are  familiar  to  all 
specialists. 

In  an  examination  of  207  patients,  taken  as  they  came, 
the  following  deformities  of  the  face  were  found: 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


299 


TOTAL  DEFORMITIES  IN  THE  JAWS  OF  THE  BLIND. 


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Per  cent. 

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7.7 

7.3 

18.3 

3.3 

4.3 

5.3 

4.8 

One  case  cleft  palate. 


In  twenty-seven  examinations  of  congenitally  blind 
patients,  all  possessed  either  deformities  of  the  head,  face, 
jaws  or  teeth. 


CHAPTER  XXVIl. 

NEUROSES  OF  DEVELOPMENT  OF  THE  BONES  OF 

THE  EAR. 

It  is  scarcely  necessary  to  refer  to  the  fact  that  aural  affec- 
tions are  frequently  a  result  of  degeneracy,  exhibiting  itself 
under  the  various  forms  of  deformity  implicating  the  audi- 
tory apparatus.  Thus  we  have  total  absence  of  the  external 
•^  ear,  together  with  an  embryonic  internal  ear.  The  mere  fact 
of  the  exceedingly  primitive  structure  of  the  internal  audi- 
tory mechanism  necessitates  abnormal  or  defective  hearing 
power  as  a  consequence.  It  is  to  this  fact  that  many  cases  of 
congential  deaf-mutism  owe  their  origin,  inasmuch  as  the 
auditory  mechanism  is  not  in  a  condition  to  appreciate  sound, 
even  though  the  individual  may  not  have  been  born  deaf,  the 
state  of  deaf-mutism  from  inability  to  appreciate  sound  and 
the  whole  auditory  apparatus  subsequently  degenerates.  Of 
course,  a  mental  defect  is  sometimes  superadded,  thus  aggra- 
vating the  case. 

As  in  the  case  of  the  congenitally  blind  and  persons  who 
become  blind  early  in  life,  the  author  has  so  far  been  unable 
to  study  particular  cases  of  deaf-mutism,  owing  to  the  fact 
that  it  is  so  difficult  in  this  country  to  obtain  skulls,  the  his- 
tory of  which  is  known. 

Speaking  upon  general  principles,  and  what  is  known 
about  the  congenitally  deformed  ears,  it  stands  to  reason  that 
if  deformities  of  the  head,  face,  jaws,  nose,  antra,  vaults,  etc., 
are  common  in  neurotics  and  degenerates,  stigmata  of  the 
bones  of  the  ear  certainly  must  occasionally  take  place. 
Taking  into  consideration  the  complicated  structure  of  which 
the  bone  and  sundry  parts  of  the  ear  are  composed,  lesions  of 
the  ear  must  in  many  cases  be  attributed  to  such  deformities. 
In  an  examination  of  1,93.5  patients,  taken  as  they  come,  the 
following  deformities  of  the  jaws  were  observed: 


300 


THE     HEAD,    FACE,    JAWS    AND   TEETH 


301 


TOTAL  DEFORMITIES  IN  THE  JAWS  OF  THE  DEAF  AND  DUMB. 


6 

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Protrusion 
Lower 
Jaw. 

Protrusion 
Upper 
Jaw. 

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Shaped 
Arch. 

C/3 

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538 
363 

197 

108 

41 
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108 
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1935 

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45.3 

305 

92 

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169 

192 

203 

113 

Per  c 

ent. 

15.7 

4.7 

10.5 

21.7 

8.7 

9.9 

10.4 

5.8 

Two  cases  cleft  palate. 


In  an  examination  of  143  cases  of  congenital  deaf  mutes 
93  per  cent  of  them  possessed  deformities  of  the  head,  face, 
jaws  and  teeth. 


CHAPTER   XXVIII. 

neuroses  of  development  of  jaws  of 
apparp:ntly  normal  individuals. 

That  the  deformities  of  the  jaws  of  the  neurotics  and  degen- 
erates as  found  in  our  asyhims  may  be  compared  with  those 
whom  we  meet  in  every-day  life,  the  author  examined  the 
mouths  of  1,000  school  children  over  twelve  years  of  age  and 
1,000  adults,  patients  and  friends,  with  the  following  results: 

TOTAL   DEFORMITIES    IN    THE   JAWS    OF    CHILDREN. 


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TOTAL   DEFORMITIES   IN    THE    JAWS    OF    ADULTS. 


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302 


THE    HEAD,    FACE,    JAWS    AND   TEETH  303 

In  comparing  the  figures  in  the  two  tables  it  will  be  seen 
that  there  is  15  per  cent  more  deformities  in  grown  people 
than  in  children.  This  can  be  accounted  for  in  three  ways: 
(1)  That  as  people  grow  older  it  is  possible  for  some  of  the 
slight  forms  of  irregularities  of  the  teeth  to  become  more 
prominent,  owing  to  the  movement  and  permanent  arrange- 
ment of  the  teeth  later  in  life.  (2)  As  the  examination  of  the 
mouths  of  the  children  was  made  some  years  ago,  it  is  possi- 
ble that  the  eye  was  not  as  well  trained  as  it  is  at  the  present 
time.  It  will  also  account  for  the  difference  in  the  classifica- 
tion of  deformities.  (3)  Part  of  these  examinations  are  those 
of  my  patients,  which  would  also  swell  the  list  of  deformities. 
The  percentage  of  deformities,  however,  com  pares  very  favor- 
ably with  the  percentage  of  deformities  of  the  face.  Taken  as 
a  whole  they  give  an  approximate  idea  of  the  percentage  of 
deformities  in  this  community  at  least.  It  is  possible,  how- 
ever, for  the  facial  bones  to  become  excessively  developed  or 
arrested  and  the  jaws  normal,  and  it  is  also  possible  for  the 
jaws  to  be  deformed  and  the  face  apparently  normal.  As 
compared  with  degenerate  classes  found  in  our  asylums  the 
percentage  is  from  25  to  33  per  cent  less. 


CHAPTER  XXIX. 

NEUROSES  OF  DEVELOPMENT  OF  THE  MAXIL- 
LARY BONES. 

Excessive  growth  of  bone-tissue  is  frequently  seen  in  con- 
nection with  the  superior  and  inferior  maxill?B.  It  may  be  a 
natural  growth  or  the  result  of  disease.  If  the  jaw  is  natur- 
ally large,  it  will  develop  gradually,  and  will  not  attain  its 
full  size  before  the  age  of  from  twenty-six  to  thirty-six  years. 
The  size  of  the  jaw  corresponds  quite  closely  to  the  size  of 
the  head,  other  things  being  equal,  the  large  head  containing 
the  large  jaw.  We  occasionally  find,  however,  a  very  small 
jaw  in  a  very  large  head,  and  vice  versa.  The  upper  jaw  is 
more  subject  to  morbid  influences  than  the  lower  jaw, 
because  of  its  development  in  connection  with  the  bones  of 
the  head.  The  lower  jaw  rarely  exceeds  the  average  size.  It 
is  possible,  however,  by  constant  use,  to  increase  the  size  of 
the  jaws,  as  is  shown  in  acrobats  and  those  who  use  their  jaws 
in  performing  various  feats,  like  "  the  man  with  the  iron 
jaw."  The  jaws  of  tobacco-chewers,  singers,  public  speak- 
ers, and  the  skulls  of  the  early  races  who  lived  upon  corn, 
shells,  roots,  etc.,  show  that  the  jaws  may  be  increased,  or  at 
least  favored  in  their  development,  in  size,  by  use. 

Enlargement  of  the  jaw-bones  is  an  occasional  cause  of 
dental  irregularities.  It  may  occur  in  either  jaw,  but  gener- 
ally in  the  upper,  and  is  due  to  hypertrophy  on  the  one  hand, 
or  hyperplasia  upon  the  other;  also  to  osteitis,  periostitis, 
continued  irritation  drawing  blood  to  the  part,  and,  in  some 
cases,  to  disease  of  the  antrum  and  nasal  fosses,  producing 
the  same  effect.  Disease  of  the  antrum  may  cause  either 
periosteal  or  osteal  enlargements.  Hereditary  syphilis  has 
an  especial  predilection  for  the  cones,  particularly  at  the 
junction  of  epiphysis  and  diaphysis.  The  growth  of  the 
teeth  does  not  proportionately  increase,  and  the  consequent 
disproportion  between  the  teeth  and  jaws  necessarily  pro- 
duces a  deformity.     The  forms  of  irregularities  of  the  teeth 

304 


THE     HEAD,    FACE,    JAWS    AND   TEETH  305 

that  co-exist  with  crowded  arches  are  not  seen  in  enlarged 
jaws.  Rachitis  in  children,  whether  due  to  syphilis  or  not, 
causes  hypertrophy  and  hyperplasia  of  the  jaws.  The  hyper- 
trophy and  hyperplasia  may  be  localized  in  some  portion  of 
the  jaw,  causing  it  to  be  unevenly  developed.  As  illustrative 
of  the  interesting  character  of  some  of  these  conditions 
described,  I  take  the  liberty  to  present  a  few  cases  which  have 
come  under  my  notice. 

Case  I.* — Arrest  of  development.  Girl,  aged  ten  years. 
Father  and  mother  have  well-developed  jaws.  Consumption  on 
father's  side;  cancer  on  mother's  side.  Child  scrofulous, 
with  small  bones,  especially  the  maxillary  bones,  which  are 
unusually  small.  The  teeth  of  both  jaws  (permanent  first 
molars  and  incisors,  temporary  cuspids  and  molars)  are  in  a 
very  crowded  condition.  The  teeth  are  normal  in  size.  With 
such  unusually  small  jaws,  and  the  teeth  at  this  age  being  very 
crowded,  I  shall  watch  this  case  with  great  interest,  f  I 
shall  expect  to  find  marked  V  or  saddle-shaped  arches.  I 
have  observed  similar  results  in  like  cases. 

Case  II. — Arrest  of  development.  Girl,  aged  sixteen 
years.  When  quite  3'oung  had  a  severe  attack  of  scarlet 
fever,  and  the  arrest  of  the  development  of  the  bony  frame- 
work resulted.  The  jaws  are  unusually  small,  and  the  teeth 
are  crowded  to  such  an  extent  that  the  cuspids  remain  out- 
side the  arch. 

Case  III.  — Enlargement  of  the  superior  maxilla.  George 
W.,  aged  fourteen  years.  This  boy  was  sent  to  me  for  an 
opinion  in  regard  to  his  teeth.  Upon  examination  I  found 
the  teeth  of  the  normal  size.  Spaces  existed  between  all  the 
teeth  as  far  back  as  the  first  permanent  molars.  The 
bicuspids  were  not  fully  developed,  but  were  through  the 
gum  sufficiently  to  notice  their  position  in  connection  with 
the  other  teeth.  The  spaces  were  not  uniform,  those  between 
the  incisors  being  the  largest.  The  widest  space  was  between 
the  central  incisors;  the  incisors  of  the  lower  jaw  coming  in 

*This  case  was  noticed  in  the  second  edition.  1890. 

t  This  girl  is  now  under  treatment.  The  jaws  are  arrested  in  their  devel- 
opment, and  a  marked  V-shaped  arch  was  produced. 


306  ETIOLOGY  OF   OSSEOUS   DEFORMITIES  OF 

contact  with  the  mucous  membrane  of  the  mouth  posterior  to 
the  superior  incisors. 

Case  IV. — Hypertrophy  of  the  jaw.  J.  B.,  aged  nineteen 
years.  This  patient  came  under  my  treatment  in  June,  1887. 
When  fourteen  years  of  age  he  received  a  blow  upon  the  side 
of  the  jaw.  He  is  of  a  scrofulous  nature.  The  blow  pro- 
duced a  low  form  of  inilammation,  and  h3qiertrophy  of  the 
bone  supervened.  The  teeth  of  that  side  of  the  jaw  were 
carried  laterally,  and  spaces  existed  between  the  bicuspids 
and  molars. 

Case  V. — Antrum  disease.  Boy,  aged  seven  years.  Ger- 
man descent;  born  in  this  country;  scrofulous.  Quite  a 
deformity  was  noticed  upon  the  left  side  of  the  face,  pro- 
duced by  the  bulging  of  the  antral  wall.  Hypertrophy  of 
the  alveolar  process  also  existed.  The  temporary  teeth  on 
the  left  side  of  the  upper  jaw  extended  beyond  those  of  the 
lower  jaw.  Upon  opening  into  the  antrum  a  thick,  ropy 
fluid  exuded.  After  three  months'  treatment  no  improve- 
ment has  been  noticed. 

DEVELOPMENT  OF  THE  INFERIOR  MAXILLA  BY  EXERCISE. 

The  superior  maxilla  is  influenced  to  a  greater  degree  by 
the  various  causes  of  jaw-deformities  than  the  inferior  max- 
illa. The  bones  of  the  upper  jaw  are  in  direct  contact  with 
the  other  bones  of  the  body,  while  the  lower  jaw,  unlike  all 
the  other  bones,  develops  independently,  and  is  only 
attached  at  its  remote  extremities  by  articulation.  The 
growth  of  the  body  of  the  bone  is  free  to  develop  or  to  remain 
in  a  dwarfed  condition,  depending  wholly  upon  its  nerve  and 
blood-supply  for  its  nourishment.  The  superior  maxilla,  as  has 
been  stated,  shows  indications  of  gradually  diminishing  in 
size.  The  inferior  maxilla,  although  under  the  same  influ- 
ences, has  a  powerful  factor  to  aid  its  preservation,  viz., 
motion  and  exercise.  On  this  account  the  question  presents 
itself,  as  to  what  extent  certain  properties  of  the  jaws,  influ- 
enced by  habit  (use),  may  be  transmitted.  The  tissues  of  the 
body,  especially  those  of  the  osseous  and  muscular  systems, 
possess  a  certain  degree  of   plasticity,  by  which  they  are 


THE     HEAD,    FACE,    JAWS   AND   TEETH  307 

enabled  to  change  their  weight  or  shape.  This  quality 
depends  upon  the  use  of  muscles  and  bones.  Among  verte- 
brates we  find  a  close  relation  between  the  muscles  and  the 
bones  upon  which  they  are  inserted.  The  union  is  made  up 
of  tendons,  which  are  prolongations  of  the  muscles  to  the 
periosteum,  and  the  periosteum  is  attached  to  the  bones. 
Powerful  muscles  and  large  bones  are  always  associated, 
exercise  developing  them  both  simultaneously.  As  outward 
changes  occur  in  the  life  of  human  beings  or  animals,  adjust- 
ment to  environment  tends  to  alter  the  physical  character- 
istics. These  changes  often  occur  through  such  gradual  mod- 
ifications that  from  one  generation  to  another  but  little 
marked  difference  is  noticed,  but  the  structure,  in  the  course 
of  a  number  of  generations,  will  so  change  that  a  new  species 
will  be  developed.  Any  animal  domesticated  from  a  wild 
life  shows  this  change,  and  among  human  beings  the  negro 
imported  from  Africa  will,  after  several  generations  have  a 
less  prominent  jaw-bone,  and  the  frontal  bone  will  become 
more  prominent.*  The  changes,  although  existing  in  the 
white  races,  after  intermarriage  with  other  nations,  are  not 
so  pronounced  and  rapid  as  in  the  negro  cross-breed,  but  are 
gradually  occurring.  No  part  of  the  body  demonstrates 
these  changes  so  forcibly  as  the  superior  or  inferior  maxilla. 
The  extremities  must  be  measured  and  weighed  to  compare 
the  two  halves  of  the  body. 

The  accustomed  eye  can  at  a  glance  compare  the  jaws  and 
teeth  and  observe  the  slightest  deviation.  Whatever  views 
are  held  regarding  the  origin  of  man,  it  cannot  be  denied 
that  the  human  jaws  of  the  earlier  races  resembled  those  of 
the  anthropoid  ape,  whose  upper  and  lower  maxillae  protruded 
and  appear  to  be  uniform.  Observation  will  show  that  the 
changes  in  the  shape  of  head  and  jaws  are  not  confined  to  one 
race  nor  to  past  generations,  but  are  continually  progressing. 
These  changes  are  not  uniform  in  the  two  jaws.  The  supe- 
rior maxilla  is  a  fixed  bone,  and  the  inaction,  from   lack  of 

*  In  some  instances  the  laws  of  hereditary  and  sexual  selection  neces- 
sarily co-operate  with  environment  in  producing  this  change. 


308  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

exercise,  gradually  affects  and  diminishes  the  volume  of  bone- 
tissue  from  one  generation  to  another. 

The  inferior  jaw,  on  the  other  hand,  is  constantly  in 
motion,  which  causes  a  flow  of  blood  to  the  part,  and  the 
activity  of  nutrition  in  the  muscles  and  bone  increases  their 
size  and  strength.  This  increase  of  the  bone  by  exercise  of 
the  part  has  been  alluded  to  by  C.  Harting  in  reports  of 
examinations  made.  He  says  that  "the  bones  of  the  right 
upper  limb  are  generally  larger  than  those  of  the  left."  This 
increase  in  size  was  not  confined  to  one  bone,  but  to  all  the 
bones  of  the  right  limb.  The  weight  of  the  right  arm  with- 
out the  hand  is  to  the  weight  of  the  left  arm  without  the  hand 
as  106.2:  100,  a  difference  of  about  six  per  cent,  which  would 
indicate  not  only  an  increase  in  the  volume  of  muscle,  but  in 
the  weight  of  the  bone.  Exercise  of  the  inferior  maxilla,  which 
has  always  existed,  has  developed  the  jaw,  while  the  superior 
maxilla  has  dwarfed  from  non-exercise.  The  contour  and 
expression  of  the  face  depend,  to  a  great  extent,  upon  the 
shape  of  the  inferior  maxilla.  Frequently  this  bone  will 
exhibit  peculiar  family  characteristics  in  early  life.  Of tener, 
family  resemblances  are  not  established  until  the  individual 
has  attained  his  full  growth,  from  the  thirtieth  to  the  fortieth 
year.  Hereditary  peculiarities  may  exist  at  birth,  like  the 
transmission  of  features,  or  color  of  eyes  or  hair,  but  family 
likenesses  may  not  appear  until  middle  life,  like  the  contour 
of  the  face,  shape  of  the  nose,  or  shape  or  size  of  the  inferior 
maxilla.  Such  being  the  case,  it  may  be  assumed  that  motion 
and  exercise  are  the  prime  factors  in  assisting  the  develop- 
ment of  the  inferior  maxilla. 

ASYMMETRY  OF  THE  LATERAL  HALVES  OF  THE  MAXILLARY 

BONES. 

Asymmetry  of  the  lateral  halves  of  the  maxillary  bones 
exists  in  the  present  era  of  the  human  race,  and,  like  other 
irregularities  and  imperfections  in  the  structure  of  the  body, 
it  prevails  to  a  greater  extent  among  neurotics  and  degener- 
ates, and  among  the  offspring  of  mixed  races,  than  in  clannish 
tribes  or  nations.       Each  lateral  half  of  the  body  develops 


THE     HEAD,    FACE,    JAWS   AND   TEETH  309 

independently  of  the  other.  The  jaws,  like  other  members, 
are  infiaenced  by  the  independent  growth  of  the  two  halves, 
so  that  each  has  its  own  peculiarities.  Asymmetry,  there- 
fore, is  caused  from  an  inharmonious  lateral  development  of 
the  parts.  The  superior  and  inferior  maxillary  bones,  grow- 
ing independently  of  each  other,  may  be  subjected  to  peculiar 
conditions  of  environment,  so  that  the  result  of  their 
development  may  be  asymmetry  of  the  jaws.  Extreme 
asymmetry  of  the  lateral  halves  of  the  human  body  is  fre- 
quently observed,  and,  as  some  of  the  recorded  cases  are  of 
special  interest,  I  will  mention  a  few  of  them. 

These  cases  are  so  marked  that  they  are  noticeable  by  the 
most  casual  observer.  In  measuring  the  lateral  halves  of  the 
body  by  the  system  of  measurement  of  criminals  and  convicts, 
introduced  some  years  ago  by  M.  Bertillon,  we  shall  find 
that  the  halves  do  not  harmonize  in  a  single  instance.  These 
differences  are  not  altogether  inherited  or  natural,  but  have 
been  acquired,  to  a  certain  extent,  by  exercise  of  the  part. 
Marked  illustrations  of  development  by  exercise  are  seen  in 
the  blacksmith,  whose  right  arm  is  larger  and  will  weigh 
heavier  than  the  left.  The  peddler  who  carries  a  pack  has 
the  side  most  in  use  developed  more  than  the  other. 

If  exact  measurements  of  the  maxillary  bones  could  be 
made,  a  lack  of  harmony  in  the  lateral  halves  would  be 
observed  in  weight,  shape  and  size.  The  difference  is  gen- 
erally not  sufficient  to  affect  the  contour  of  the  face,  but 
causes  faulty  articulation  to  the  teeth  upon  that  side  of  the 
face.  This  is  generally  due  to  the  number  of  teeth  that 
remain  in  the  jaw  late  in  life.  Thus  a  molar  or  bicuspid 
may  never  have  developed  upon  one  side,  while  the  full  num- 
ber are  in  position  upon  the  other  side,  or  they  may  have 
been  extracted  upon  one  side,  while  the  full  number  remain 
upon  the  other.  Again,  owing  to  an  irregularity  of  the  teeth 
in  the  anterior  part  of  the  mouth  the  posterior  teeth,  although 
all  are  present,  may  have  moved  forward.  In  any  of  these  con- 
ditions the  alveolar  process  and  jaw  would  become  shorter 
upon  one  side  than  upon  the  other,  owing  to  absorption  of  the 
alveolar  process.     The  deformities  of  either  lateral  side  of  the 


310 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


superior  maxilla  are  not  necessarily  like  those  of  the  inferior. 
Excessive  growth  or  arrested  development  appear  upon  both 
sides  of  the  jaws,  sometimes  on  the  right  and  again  upon  the 
left.  Examinations  of  these  deformities  can  be  made  only 
when  the  second  teeth  have  been  extracted  and  the  alveolar 
process  has  been  absorbed. 

Fig.  92  shows  the  superior  maxilla  after  absorption  has 
taken  place.  If  a  line  be  drawn  through  the  jaw  at  the  median 
line,  it  will  be  seen  that  the  left  half  is  fully  developed,  while 
the  right  half  is  contracted  at  the  bicuspid  region.  The  fol- 
lowing statistics  show  the  deformities  in  the  contour  of  jaws 
modeled  by  Dr.  L.  P.  Haskell,  of  Chicago,  who  has  a  large 


Fig.  92. 

collection   of  models,  and  who  kindly  assisted  me  in   their 
examination: 

UPPER   .JAW. 


Total  number  examined, 

Total  number  normal, 

Total  number  abnormal,  right  side. 

Total  number  abnormal,  left  side. 


298 

137 

73 

88 


Fig.  93  illustrates  the  inferior  maxilla  after  the  teeth  have 
been  extracted  and  absorption  of  the  alveolar  process  has 
taken  place.  By  drawing  a  line  through  the  center  of  the 
low^er  jaw  at  the  median  line,  a  wider  space  may  be  seen  to 
exist  between  the  line  and  the  left  side  than  on  the  other  side. 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


311 


LOWER  JAW. 

Total  number  examined,         -         -        -       154 

Total  number  normal,  -        -        -     -        64 

Total  number  abnormal,  right  side,         -         12 

Total  number  abnormal,  left   side,         -        88 

In  the  study  of  irregularities  of  the  teeth  during  the  past 

eight  or  ten  years,  I  have  observed  that,    although  no  two 

cases  of  irregularities  of  the  teeth  are  exactly  alike,  there  is  a 

general  similarity  of   shape  and  outline  of  alveolar  process 

and  jaw,  owing  to  similar  environments  during  eruption  of 

the  teeth.     Upon  the  hypothesis  that  the  two  halves  of  the 


Fig.  93. 

superior  maxilla  are  developed  in  proportion  to  the  excess  of 
food  masticated  on  one  side  or  the  other,  depending  upon 
right  and  lef  t-handedness  of  the  individual,  we  suppose  that 
the  case  illustrated  is  that  of  a  left-handed  person,  as  the  left 
side  of  the  jaw  is  larger.  But  it  appears  that  this  side  is  nor- 
mal in  size  and  the  right  is  deficent  in  development.  By 
examining  carefully  the  contour  of  patients'  teeth,  we  shall 
observe  that  but  few  arches  are  uniforrd.  While  one  side 
may  be  normal  the  other  will  be  depressed.  Fig.  94  shows 
such  a  deformity.  This  cut  is  taken  from  a  model  of  an 
extreme  case  of  irregularly-shaped  jaw.     It  represents  a  per- 


312  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

feet  semi-V-shaped  arch.  (I  find  in  my  eollection  of  models 
thirtj'-eight  of  this  variety  of  deformity,  tweuty-four  of 
which  are  on  the  right  side  and  fourteen  on  the  left.)  Most 
of  these  irregularities  are  not  quite  as  depressed  at  the  cuspid 
region  as  the  cut  indicates.  No  two  are  exactly  alike  as 
regards  the  position  of  the  teeth,  and  yet  the  similarity  is  so 
complete  that  a  non-professional  man  would  immediately  take 
notice  of  it.  The  asymmetry  of  the  jaw  illustrated  in  Fig.  92 
is  probably  caused  by  the  peculiar  arrangement  of  the  per- 
manent teeth  in  the  arch,  since  the  deformity  is  not  apparent 
during  the  first  set  of  teeth,  the  alveolar  process  and  maxillary 
bones  being  molded  into  this  peculiar  shape  thereby.  Since 
but  few  people  are  left-handed,  this  percentage  is  very  large, 
showing  twenty -four  out  of  thirty-eight  cases  with  deficiencies 
on  the  riffht  side,  when  we  might  look  for  normal  or  exces- 


Fig.  94. 

sive  development  on  that  side.  The  cause  of  this  irregularity 
I  believe  to  be  local  in  its  origin,  viz.,  too  early  extraction  of 
the  temporary  teeth  upon  the  afiected  side,  thus  showing  that 
one  side  is  as  liable  to  be  affected  as  the  other.  The  mechan- 
ism of  this  irregularit}^  will  be  found  under  the  head  of  local 
causes. 

The  asymmetry  upon  the  lower  jaw  may  be  traced  to  two 
causes: 

First.  The  full  number  of  teeth  retained  upon  the  long 
side.  If  the  third  molars  should  develop  on  one  side  only, 
the  jaws  on  that  side  would  expand  b}^  the  crowded  condition 
of  the  teeth  and  extend  farther  from  the  median  line  than 
otherwise.  The  loss  of  the  third  molars  by  extraction  or 
non-development  Avould  prevent  the  other  side  from  increas- 
inof  to  the  natural  size. 


THE     HEAD.    FACE,    JAWS   AND   TEETH  313 

Second.  The  relation  of  the  upper  teeth  to  the  lower  teeth. 
The  articulation  of  the  inferior  maxilla  with  the  cranium  is 
so  remote,  and  the  contour  of  the  two  bones  so  unlike,  that 
uniformity  of  bone-structure  cannot  be  looked  for.  When 
we  consider  the  complexity  of  the  development  of  bone-tis- 
sues, first  of  the  maxillary  bone,  then  of  the  alveolar  process, 
and  lastly  of  the  two  sets  of  teeth,  it  is  a  wonder  that  har- 
mony ever  prevails. 

ASYMMETRY  OF  THE  MAXILLARY  BONES. 

HmkelVs  Deformity.'^ — When  we  examine  models  of  the 
superior  maxilla  after  absorption  of  the  alveolar  process  has 


Fig.  95. 

taken  place,  we  observe  that  in  the  cuspid  and  bicuspid 
region,  high  above  the  alveolar  border,  a  marked  depression 
exists  on  either  side.  Fig.  95  shows  a  base-plate  which  has 
been  formed  over  such  a  model.  The  plate  is  more  depressed 
at  the  left  than  at  the  right  side.  This  peculiar  deformit}'  is 
familiar  to  the  operator  who  arranges  teeth  and  waxes  up 
plates  for  the  purpose  of  restoring  the  contour  of  the  face. 
Upon  closer  inspection  of  the  model  it  will  be  seen  that  there 
is  an  asymmetry  of  the  lateral  halves  of  the  maxillary  bones. 
With  Dr.  Haskell's  assistance,  I  have  examined  298  models, 

*I  have  named  this  deformity  "  Haskell's  Deformity,"  for  the  reason  that 
Dr.  Haskell  called  the  attention  of  the  profession  to  this  peculiar  condition  of 
the  maxillary  bones  years  a?o,  personally  and  through  the  journals,  and  says  he 
has  found  but  one  dentist  who  had  observed  it. 


314  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

tinding  268  out  of  the  number  with  marked  depression  on  the 
left  side,  and  twenty-four  with  the  depression  on  the  right 
side,  and  only  six  cases  showed  both  sides  to  be  alike.  It  is 
remarkable  that  so  large  a  proportion  of  the  cases  of  this 
deformity  should  be  found  existing  on  the  left  side. 

Dr.  Haskell  says:  "For  many  years  I  have  observed  a 
marked  difference  between  the  right  and  left  sides  of  models 
of  both  the  upper  and  lower  jaws,  but  more  especially  notice- 
able in  the  upper  jaw.  It  is  not  so  apparent  upon  a  casual 
glance  at  the  model,  for  it  is  not  so  much  in  the  alveolar  pro- 
cess as  in  the  maxillary  bones.  But  a  plate  swaged  upon  a 
model  from  an  impression  taken  high  over  the  region  of  the 
cuspids  (as  ought  always  to  be  done)  shows  at  once  the  depres- 
sion of  the  left  side,  which  occurs,  to  a  greater  or  less  extent, 
in  ninety-five  per  cent  of  cases.  The  difference  becomes 
apparent  in  arranging  artificial  teeth.  Every  dentist  of  expe- 
rience must  have  observed  that  greater  length  of  teeth  and 
gums  is  required  upon  the  left  side  than  upon  the  right. 
How  often  it  is  seen  that  the  left  side  of  the  lip  rises  higher, 
in  talking  and  laughing,  than  the  right  side.  The  difference 
in  the  two  sides  of  the  lower  jaw  does  not  occur  as  often,  but 
is  apparent  in  the  divergence  of  the  left  side  from  a  line 
drawn  through  the  centre  of  the  model,  so  that  the  posterior 
teeth  on  that  side  must  be  set  farther  in  upon  the  plate." 

Dr.  Haskell  has,  during  the  past  twelve  years,  frequently 
called  my  attention  to  this  peculiar  deformity  of  the  jaw. 
My  own  observation  of  models  and  patients  has  also  indicated 
the  probability  that  the  majority  of  deformities  of  this  nature 
exist  on  the  left  side.  The  following  theory  for  this  deform- 
ity suggests  itself  as  worthy  of  our  consideration:  Man,  like 
some  other  members  of  the  animal  kingdom,  moves  the  lower 
jaw  from  right  to  left  in  mastication.  (As  people  are  some- 
times left-handed,  so  it  is  possible  to  find  cases  where  the 
jaws  moved  from  left  to  right.  I  have,  however,  found  only 
three  such  cases.)  The  constant  friction  of  the  lower  teeth 
against  the  upper,  carries  the  superior  arch  with  the  alveolar 
process  toward  the  left.  By  pressing  the  index  finger  over 
the  cuspid  and  bicuspid  roots,  above  the  alveolar  process,  we 


THE    HEAD,    FACE,    JAWS    AND   TEETH  315 

shall  find  that  the  majority  of  mouths  contain  teeth  with  their 
roots  standing  out  more  prominently  upon  the  right  side  than 
upon  the  left  side.  The  right  superior  dental  arch,  like  the 
arch  of  a  bridge,  resists  such  inward  force  because  of  the 
lateral  contact  of  its  teeth.  On  the  contrary,  the  left  supe- 
rior dental  arch  may  thus  be  carried  slightly  outward.  The 
limited  lateral  motion  during  occlusion  prevents  the  teeth  and 
alveolar  process  from  being  carried  farther.  The  cuspid 
tooth  may  be  prevented  from  being  carried  in  as  far  as  it 
otherwise  would  be  owing  to  the  lateral  motion  of  the  lower 
jaw  to  the  left.  The  alveolar  process  is  thus  carried  beyond 
the  border  of  the  maxillary  bones.  After  the  teeth  have  been 
removed,  absorption  of  the  alveolar  process  occurs,  leaving 
only  the  alveolar  ridge.  The  ridge  then  overhangs  the  max- 
illary bone,  thus  producing  a  depression  upon  the  left  side. 
This  is  the  reason  that,  in  arranging  artificial  dentures  in 
many  cases,  the  teeth  are  carried  over  the  alveolar  border 
farther  than  upon  the  right  side  to  obtain  proper  articulation 
with  the  natural  teeth  upon  the  lower  jaw. 

On  examining  the  model  upon  which  the  base-plate  was 
formed,  it  will  be  seen  that  both  the  right  and  left  alveolar 
borders  are  symmetrical.  The  alveolar  border  in  most  cases 
indicates  the  contour  of  the  teeth  when  in  position. 

ASYMMETRY   IN   THE    RAMI. 

A  case  recently  seen  with  Dr.  G.  Frank  Lydston,  of  this  city, 
is  a  marked  illustration  of  congenital  maxillary  asymmetry. 
The  man  is  thirty  years  of  age.  The  inferior  maxillary  is 
small  and  the  chin  pointed  and  narrow.  There  is  a  diflfer- 
ence  of  one-half  an  inch  in  the  length  of  the  rami,  the  left 
ramus  being  the  shortest.  The  diflference  is  suflicient,  when 
the  face  is  smoothly  shaven,  to  produce  a  noticeable  deform- 
ity. The  teeth  are  irregular  in  both  jaws,  the  irregularity, 
however,  being  most  marked  in  the  superior  jaw.  The  cra- 
nium partakes  of  the  asymmetry,  and  the  frontal  suture  is 
plainly  marked.  Numerous  irregularities  of  the  surface  of 
the  skull  are  observable.  The  larynx  is  displaced  at  least 
one-half  an  inch  from  the  median  line  toward  the  left  side. 


316  ETIOLOGY   OF  OSSEOUS  DEFORMITIES  OF 

There  is  no  history  of  injury,  and  a  point  of  interest  in  this 
case  is  the  fact  that  the  asj-mmetrical  and  small  jaw  is  a  fam- 
ily characteristic,  and  has  been  noticed  for  several  gener- 
ations. The  jaw,  in  this  case,  resembles  the  father's,  while 
the  arrangement  of  the  teeth  is  similar  to  that  of  the  mother. 
The  upper  portion  of  the  body  appears  to  have  been  developed 
in  two  lateral  halves,  and  when  brought  together  the  left  side 
of  the  body  was  higher  than  the  right  side.  The  cranium 
and  maxillary  bones  show  this  deformity  quite  conspicuously. 
The  teeth,  which  are  comparatively  sound,  are  all  present. 
The  left  superior  maxilla  is  considerably  higher  than  the 
right.  Occlusion  is  perfect,  thus  compensating  for  the  short 
left  ramus. 

Another  very  interesting  case,  and  similar,  is  that  of 
a  young  lady,  twenty  years  of  age.  Has  arrest  of  develop- 
ment of  the  upper  jaw;  the  body  of  the  lower  jaw  is  exces- 
sively developed.  Length  of  right  ramus,  2.25  inches;  left, 
1.50  inches.  The  result  of  which  is  the  lower  jaw  thrown 
to  the  left  the  width  of  the  right  central  incisor  tooth.  I  am 
informed  that  the  father  and  uncle  possess  a  similar 
deformity. 

ASYMMETRY    IN    THE    BODY    AND    IMPROPER    OCCLUSION. 

The  daughter  of  an  old  patient  came  to  me  for  treatment 
September  14,  1888.  She  was  about  seventeen  years  old,  and 
had  quite  a  prominence  upon  the  right  side  of  the  lower  jaw, 
and  another,  although  not  so  marked,  upon  the  left  upper 
jaw.  The  left  corner  of  the  mouth  was  nearly  one-quarter  of 
an  inch  higher  than  the  right.  The  face  was  full  and  had  a 
peculiar  expression,  owing  to  the  mouth  and  jaw  being  at  an 
angle  when  closed.  Upon  examination,  1  found  the  left 
superior  maxilla  one-quarter  of  an  inch  higher  than  the  right 
side.  The  alveolar  process  and  teeth  shared  the  same  irregu- 
larity, thus  placing  the  line  of  the  teeth  on  the  same  plane  as 
the  lips.  The  body  of  the  inferior  maxilla,  from  the  sym- 
physis to  the  angle,  seemed  to  be  longer  upon  the  left  side 
than  upon  the  right.  When  the  jaw  closed,  the  median  line 
of  the  lower  jaw  was  half  an  inch  to  the  right  of  the  upper. 


THE     HEAD,    FACE,    JAWS    AND   TEETH  317 

The  lingual  cusps  of  the  bicuspids  and  molars  on  the  right 
side  of  the  lower  jaw  occluded  with  the  buccal  cusps  of  the 
bicuspids  and  molars  of  the  upper,  and  vice  versa  upon  the 
left  side. 

Asymmetry  may  be  due  to  excessive  development  of  the 
body  of  the  jaw  on  one  side,  and  arrest  of  development  on 
the  other. 

The  two  cases  just  described  are  interesting  from  the  fact 
that  while  the  causes  and  the  external  appearances  of  the  face 
are  entirely  different,  the  alveolar  processes  and  the  occlud- 
ing surfaces  of  the  teeth  are  on  the  same  angle,  the  inclination 
being  in  the  same  direction.  This  deformity  is  frequently 
found  in  the  mouths  of  patients  over  forty,  years  of  age,  where 
all  the  teeth  have  been  removed  upon  the  side  of  one  jaw  and 
upon  the  opposite  side  of  the  other,  the  alveolar  processes 
containing  the  teeth  elongating  upon  the  side  where  there  is 
no  antagonism,  and  throwing  the  occluding  line  of  the  teeth 
out  of  position  at  an  angle  similar  to  that  above  described. 

By  examining  the  mouths  of  1,977  idiots  there  were  found 
to  be  159  with  protrusion  of  the  superior  maxilla,  and  92  with 
protrusion  of  the  inferior  maxilla.  These  deformities  do 
not  exist  to  such  an  extent  among  healthy  individuals. 
This  inharmonious  development  of  the  maxillary  bones  may 
extend  from  the  articulation  to  the  incisor  teeth.  Such  deform- 
ities are  rarely  found  in  connection  with  the  first  set  of 
teeth.  When  the  alveolar  process  protrudes  during  the  period 
of  the  temporary  teeth,  it  is  usually  caused  by  thumb-sucking 
or  an  arrest  of  development  of  the  inferior  maxilla.  Protrusion 
of  the  inferior  maxilla  is  the  result  of  the  abnormal  development 
of  the  rami  or  body  of  the  jaw,  or  an  arrest  of  development  of 
the  superior  maxilla.  As  these  abnormal  conditions  usually 
correct  themselves  when  the  temporary  teeth  are  shed,  they 
consequently  receive  little  attention.  But  when  these  deform- 
ities arise  during  second  dentition  the  jaws  are  determined 
toward  false  positions,  thus  endangering  the  beauty  of  the 
face.  We  occasionally  see  excessive  growth  or  physiological 
hypertrophy  of  the  superior  maxilla  when  the  inferior  max- 
illa is  unusually  developed.     When  the  teeth  are  normal  in 


318 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


size  they  appear  small  in  proportion  to  the  abnormally  large 
jaw.  They  are  carried  forward  with  the  alveolar  process  to 
such  a  degree  that  the  teeth  and  lips  may  protrude.  In  such 
cases  it  appears  as  if  the  body,  or  rami,  of  the  inferior  max- 
illa were  much  shorter  than  is  natural,  but  by  close  inspection 
we  shall  see  that  the  inferior  maxilla  is  normal,  and  quite  a 
space  exists  between  the  superior  and  inferior  central  incisors. 
A  slight  protrusion  of  the  superior  teeth  is  a  common  defect; 
it  is  usually  accompanied  by  a  depression  of  the  face  at  the  root 
and  aliB  of  the  nose,  and  a  protrusion  of  the  anterior  alveolar 


Fig.  96. 


process  and  upper  lip.  If  the  maxillary  bones,  as  well  as  the 
alveolar  process,  are  enlarged,  the  teeth  will  stand  perpendic- 
ularly with  the  alveolar  process.  If  the  superior  maxillary 
bones  are  small,  the  teeth  will  protrude  from  the  perpendic- 
ular to  an  angle  of  45°.  Such  a  case  is  illustrated  by  Fig.  64, 
page  131,  Kingsley's  "Oral  Deformities."  This  is  a  deformity 
frequently  met  with  in  practice.  A  common  cause  of  pro- 
trusion of  the  superior  maxilla  is  illustrated  in  Fig.  96.*  The 
teeth  in  the  upper  jaw  are  fully  erupted,  but  are  directed 
downward  and  forward;  the  teeth  in  the  lower  jaw  are  in 
their  proper  position.      It  will  be  observed  that  the  rami 

*  These  cuts  represent  cases  in  my  practice. 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


319 


of  the  jaw  are  inharmoniously  developed,  the  rami  being 
so  short  when  the  jaws  close  that  the  occlusion  throws  the 
superior  teeth  and  alveolar  process  forward.  In  this  case 
the  alveolar  process  is  quite  thin,  because  the  arch  is  high 
and  the  teeth,  having  long  slender  roots,  are  easily  carried 
forward.  The  inferior  maxilla  is  large,  the  structure  dense 
and  hard,  and  the  teeth  firmly  fixed  in  position  in  the  jaw. 
When  occlusion  takes  place,  the  weaker  structure  (the  superior 
maxilla)  is  carried  forward  by  the  stronger  (the  lower  maxilla), 
thus  forcing  the  alveolar  process  forward,  producing  harmony 
throughout  the  articulation.  The  shortness  of  the  rami  of 
the  inferior  maxilla,  causing  improper  closing  of  the  jaws,  is 


Fig.  97. 


a  feature  strongly  impressed  upon  the  dentist  who  undertakes 
to  insert  artificial  dentures.  The  tendency  of  the  lower  jaw 
to  force  an  upper  denture  out  of  the  mouth,  by  striking  the 
teeth  at  an  angle  instead  of  perpendicularly,  is  a  marked  illus- 
tration of  the  inharmonious  development  of  the  jaws.  The 
same  difficulty  is  frequently  experienced  with  the  partial 
lower  plate  when  it  presses  against  the  anterior  teeth  and 
alveolus,  forcing  them  both  forward  by  improper  articulation. 
The  occasional  grinding  of  the  surfaces  of  the  artificial 
molars  to  produce  proper  articulation  afi'ords  another  illus- 
tration of  the  efiects  of  this  inharmonious  development. 


320  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

IMPERFECT  OCCLUSION. 

Fig.  07  illustrates  a  deformity  produced  by  the  l)efore- 
mentioned  cause;  yet  the  result  is  very  different.  The  case 
is  that  of  a  boy  fourteen  years  old.  Before  the  eruption  of  the 
second  molars,  the  articulation  was  perfect;  but  as  soon  as  the 
second  molars  occluded  the  jaws  were  forced  open.  The  rami 
are  so  short  that  when  the  second  molars  and  the  alveolar 
processes  of  the  superior  and  inferior  maxilla  come  together, 
a  space  exists  between  the  central  incisors. 

Unlike  the  former  case,  the  superior  alveolar  process  is 
remarkably  well  developed,  and  the  teeth  are  tirmly  fixed  in 
the  jaw.  The  vault  of  the  mouth  is  quite  low.  The  position 
of  the  teeth,  in  the  alveolar  process,  is  such  that  when  the 
lower  teeth  occlude  they  strike  directly  on  a  line  with  the 
long  axes  of  the  roots,  thus  preventing  the  forward  move- 
ment of  the  teeth  and  alveolar  process.  The  inferior  maxilla 
is  not  well  developed,  nor  has  it  the  power  to  overcome  the 
resistance,  and  force  the  superior  alveolar  process  and  teeth 
forward,  as  exemplified  in  Fig.  96,  When  the  rami  are  short, 
so  that  they  do  not  harmonize  with  the  maxillary  bones,  the 
movement  of  the  jaws  may  be  likened  to  the  arms  of  shears: 
the  farther  the  points  are  from  the  centre,  the  greater  the 
distance  they  have  to  travel.  A  slight  movement  at  the 
centre  will  cause  them  to  move  a  considerable  distance.  In 
a  similar  manner,  a  slight  excessive  protrusion  of  a  molar 
will  cause  the  anterior  teeth  to  become  separated.  The 
shorter  the  rami,  the  less  the  harmony  between  the  jaws  and 
teeth;  the  farther  back  the  protruding  molar,  and  the  more  it 
projects,  the  greater  the  anterior  separation  of  the  jaws. 
The  excessive  eruption  of  the  second  and  third  molars  is  very 
often  due  to  the  persons  sleeping  with  the  mouth  open,  the 
pressure  upon  the  posterior  teeth  being  removed  the  teeth, 
and  even  the  alveolar  process,  will  elongate.  Not  infrequently 
the  mal-occlusion  of  the  teeth  is  due  to  the  inability  to  close 
the  jaws  on  account  of  the  inharmonious  development. 
Occasionally  there  are  mouths  in  which  the  molars  and 
bicuspids  occlude,  and  there  is  just  enough  space  between  the 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


321 


centrals  to  admit  a  thin  spatula.  January,  1887,  a  pationt 
was  brought  to  me  for  advice  whose  jaws,  when  closed,  showed 
a  space  of  half  an  inch  between  the  incisors.  Such  cases  are 
due  to  arrest  of  development  of  the  anterior  alveolar  process 
— the  superior  dental  arch  being  too  small  for  the  inferior. 
The  pressure  of  the  jaws  upon  the  molar  teeth  is,  in  some 
instances,  so  great  that  normal  eruption  is  impossible.  In 
such  cases  the  molars  will  protrude  through  the  gum,  and  the 
superior  and  inferior  processes  will  occlude  when  the  jaws, 
meet. 


Pig.  98. 
PROTRUSIok  OF  THE  INFERIOK  MAXILLA. 

Protrusion  of  the  inferior  maxilla  produces  one  of  the 
most  repulsive  deformities  of  the  face,  and  should  be  cor- 
rected as  early  in  life  as  possible.  When  it  is  caused  by  or 
associated  with  arrested  development  of  the  superior  maxilla, 
it  is  extremely  difficult  to  restore  the  features  to  a  natural 
expression.  A  case  of  considerable  interest,  illustrated  by 
Fig.  98,  came  to  my  notice  in  1887.  A  commercial  traveler 
from  New  York  called  at  my  office  for  the  purpose  of  having 
a  gold  crown  re-set.  I  noticed  a  marked  deformity  in  the 
jaws,  consisting  of  a  depression  at  the  alse  of  the  nose  and  an 
unusual  protrusion  of  the  inferior  maxilla.      Upon  examina- 


322  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

tion  I  found  that  the  second  molar  on  the  upper  jaw  and  the 
third  molar  on  the  lower  jaw  were  the  onl}'  teeth  that 
occluded.  This  was  caused  by  arrest  of  development  of  the 
bones  of  the  face  and  an  excessive  lenp^th  of  the  rami  of  the 
lower  jaw.  The  body  was  normally  developed,  but  was  car- 
ried forward  by  a  lengthening  of  the  rami.  To  add  to  this 
deformity,  there  was  a  marked  arrest  of  development  of  the 
bones  of  the  face.  There  are  cases  where  the  lower  jaw  pro- 
jects beyond  the  upper;  but  by  closely  examining  the  deform- 
ity', we  find  that  another  cause  existsfor  this  appearance. 

A  girl,  fifteen  years  of  age,  was  sent  to  me  for  treatment 
by  a  dentist  from  a  neighboring  state.  He  desired  me  to 
"force  the  inferior  maxilla  back  into  place."  I  found  the 
rami  and  body  of  the  jaw  apparently  normal.  The  external 
appearance  of  the  chin  and  cheeks  was  in  keeping  with  the 
outline  of  the  face.  I  observed  that  the  upper  lip  was  much 
depressed,  and  that  deep  lines  extended  from  the  al^e  of  the 
nose  to  the  corner  of  the  mouth.  The  cheek  bones  were  also 
undeveloped.  Upon  opening  the  mouth  I  found  arrest  of 
development  of  the  superior  maxilla.  The  superior  incisors 
closed  inside  of  the  inferior  incisors;  the  first  and  second 
bicuspids,  first  and  second  molars,  were  in  position,  but  had 
crowded  forward  close  to  the  lateral  incisors.  The  cuspids 
were  quite  outside  of  the  arch.  The  superior  dental  arch  had 
to  1)6  forced  out,  instead  of  carrying  the  inferior  maxilla  in, 
which  would  tend  to  further  complicate  the  case. 

Another  instance  is  that  of  a  young  man  with  what  seemed 
at  first,  and  what  an  old  practitioner  had  regarded,  as  a  "prog- 
nathous lower  maxilla."  This  I  found  upon  inspection  to  be 
caused  by  arrested  development  of  the  upper  maxilla.  This 
dentist  had  spent  five  years  in  trying  to  reduce  the  deformity. 
It  was  fortunate,  however,  that  he  was  unsuccessful,  for  had  he 
succeeded  the  deformity  would  have  been  made  greater  than 
it  was.  Instead  of  moving  the  lower  teeth  back,  the  upper 
teeth  should  have  been  moved  forward.  In  six  months' 
treatment  by  this  plan  the  teeth  were  corrected  and  the  face 
was  greatly  improved. 

In  the  majority  of  cases  which  appear  to  result  from  a 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


323 


protrusion  of  the  lower  jaw,  we  shall  find  that  the  lower  max- 
illa does  not  project  abnormally,  but  the  superior  maxilla, 
being  arrested  in  its  development,  gives  the  protruding 
appearance  to  the  lower  jaw.  Before  undertaking  to  correct 
such  a  deformity  the  general  contour  of  the  face  should  be 
carefully  studied.  My  experience  has  been  that  many  mis- 
takes have  been  made  by  operators  who  did  not  understand 
the  true  condition  of  the  patient. 

A  peculiar  but  common  deformity  of  the  inferior  maxilla 
is  illustrated  in  Fig.  99.  The  body  of  the  Jaw  is  very  short. 
A  line  dropped  perpendicularly,  and  touching  the  chin  at  the 
median  line,  would  pass  through  the  bicuspid  region  of  the 


Fig.   99. 


superior  maxilla.  A  front  view  of  such  a  deformity  gives  an 
appearance  as  though  the  lower  jaw  were  absent,  and  a  side 
view  throws  the  nose  out  prominently,  while  the  chin  and 
forehead  retreat.  The  rami  of  the  jaw  are  larger  than  the 
body.  The  articulation  is  good,  the  defect  being  that  in  the 
incisor  region  the  teeth  strike  quite  a  distance  posterior  to 
the  superior  incisors.  Arrest  of  development  of  the  lower 
jaw  frequently  results  when  the  superior  incisors  are  crowded 
inward  irregularly,  or  when  there  is  arrest  of  development 
of  the  superior  maxilla  the  lower  incisors  coming  in  contact 
with  them,  thus  preventing  the  forward  development  of  the 
bod^^  of  the  jaw.     The  anterior  portion  of   the   lower  jaw 


324 


ETIOLOGY  OF  OSSEOUS  DEFOKMITIES  OF 


remains  stationary,  while  the  development  is  in  the  posterior 
direction. 

Fig.  100  represents  jaws  such  as  are  frequently  seen. 
The  long  body  and  protruding  chin,  narrow  and  contracted 
alveolar  process  on  the  lower  jaw,  a  small  superior  maxilla  and 
thin  protruding  alveolar  process  are  in  keeping  with  the  thin 
faces  and  sharp  features  of  the  class.  The  body  of  the  inferior 
maxilla  is  small,  thin  and  very  delicate;  the  rami  unusually 
short — just  the  opposite  to  the  one  last  described.  A  line 
drawn  parallel  with  the  occluding  surfaces  of  the  teeth  would 


Fig,  100. 

meet  the  angle  of  the  jaw,  which,  in  a  normal  jaw,  would 
extend  from  one  to  one  and  a  half  inches  below  the  line. 
Naturally  slender,  delicate  muscles  and  tendons  are  associ- 
ated with  such  bones.  In  these  cases  dislocation  of  the  infe- 
rior maxilla  is  liable  to  occur  while  yawning  or  during  dental 
operations,  so  great  is  the  leverage.  In  this  instance  the 
length  of  the  jaw  compensated  for  the  width,  so  that  in  this 
particular  case  the  teeth  are  not  irregular;  although  irregu- 
larity frequently  accompanies  this  peculiar  formation  of  the 
jaw.     This  is  particularly  the  case  with  the  saddle  or  V-shaped 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


325 


arches  on  the  upper  jaw,  and  the  saddle-shaped  and  forward 
inclination  of  the  molars,  bicuspids  and  cuspid  teeth  on  the 
lower  jaw.  The  roof  of  the  mouth  is  also  very  high  and  the 
alveolar  process  very  thin,  giving  the  roots  of  the  teeth  but 


Pig.  101. 

slight  support.  The  same  principle  of  organization  and 
structure  is  operative  in  the  alveolar  process  and  teeth  of  the 
lower  jaw. 

Fig.  101  represents  the  jaws  of  a  patient,  twenty -six  years 


Fig.  102. 

of  age,  who  came  to  me  for  treatment.  Upon  examination  I 
found  a  small  normal  inferior  maxilla,  well  protruded,  and 
in  harmony  with  the  other  features  of  the  face.  The  supe- 
rior maxilla  and  alveolar  process  were  excessively  developed, 


326  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

the  first  molar  and  anterior  teeth  describinof  a  much  hireer 
circle  than  the  lower.  The  second  molars  were  the  only 
teeth  that  articulated  properly.  The  anterior  alveolar  pro- 
cess had  taken  on  a  prolific  deposition  of  bone-cells  until  the 
teeth  impinged  upon  the  gum  of  the  lower  jaw,  producing 
absorption  and  expansion.  The  upper  lip  was  covered  with 
a  mustache  which  completely  hid  the  deformity.  Under  such 
conditions  a  prominence  is  observed  at  the  alaj  of  the  nose — 
the  upper  lip  being  drawn  over  the  alveolar  process. 

Fig.  102  represents  a  case  rarely  met  with.  The  body  of 
the  inferior  maxilla  is  excessively  developed,  the  extent  of 
the  irregularity  depending  on  the  degree  of  development. 
When  only  a  slight  protrusion  exists  the  incisors  strike 
beyond  the  superior  incisors.  In  extreme  cases  only  the 
molars  articulate.  When  only  the  anterior  teeth  articulate 
the  alveolar  process  develops  so  that  the  teeth  extend  to  the 
superior  alveolar  process.  The  features  may  be  quite  regu- 
lar otherwise.  This  deformity  is  common  among  negroes, 
and  is  called  prognathism.  Asymmetry  of  the  jaws  fre- 
quently continues  to  develop  until  the  osseous  system  has 
obtained  its  growth. 


CHAPTER  XXX. 

NEUROSES  OF  DEVELOPMENT  OF  THE  VAULT. 

It  is  a  singular  fact  that  depressed  palates  and  irregulari- 
ties of  the  teeth  were  first  observed  and  described  by  medi- 
cal men.  Langdon  Down  called  the  attention  of  the  medical 
profession  to  the  fact  that  high  vaults,  as  well  as  irregular- 
shaped  jaws,  were  very  common  among  idiots  and  congenital 
imbecility.  In  a  paper,  read  before  the  Odontological 
Society  of  Great  Britain,  he  says,  among  other  things,  speak- 
ing of  idiots  in  the  Earlswood  asylum:  "Of  the  most  signifi- 
cant value,  however,  is  the  condition  of  the  palate.  I  have 
made  a  very  large  number  of  careful  measurements  of  the 
mouths  of  the  congenitally  feeble-minded,  and  of  intelligent 
persons  of  the  same  age,  with  the  result  of  indicating  with 
some  few  exceptions  a  markedly  diminished  width  between 
the  posterior  bicuspids  of  the  two  sides.  One  result,  or 
rather,  one  accompaniment  of  this  narrowing,  is  the  inordi- 
nate vaulting  of  the  palate.  The  palate  assumes  a  roof-like 
form.  The  vaulting  is  not  simply  apparent  from  the  approxi- 
mation of  the  two  sides;  it  is  absolute — the  line  of  juncture 
between  the  palatal  bone  occupying  a  higher  plane.  Often 
there  is  an  antero-posterior  sulcus  corresponding  to  the  line 
of  approximation  of  the  two  bones.  An  appeal  to  the  condi- 
tion of  the  mouth  is  an  important  aid  in  determining  whether 
the  lesion,  on  which  the  mental  weakness  depends,  is  of  intra- 
uterine or  post-uterine  origin.  In  the  event  of  the  mouth 
being  abnormal,  it  indicates  a  congenital  origin;  while  if  the 
mouth  is  well  formed,  ^nd  the  teeth  are  in  a  healthy  condi- 
tion, it  would  lead  to  the  opinion  that  the  calamity  had 
occurred  subsequently  to  embryonic  life."  Indeed,  he  went 
so  far  as  to  state  that  these  conditions,  when  observed  in 
young  children,  were  pathognomonic  of  idiocy.  Upon  fur- 
ther observation,  however,  it  was  found  that  many  idiots  and 
feeble-minded  individuals  possessed  low,  narrow  vaults.  It 
was  also  observed  that  many  sane  persons  possessed  high 
vaults,  and  V,  and  saddle-shaped  arches. 

387 


328  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

Dr.  Clay  Shaw*  made  extensive  observations  and  accurate 
measurements  of  the  mouths  of  idiots,  and  decided  that 
"  there  is  no  necessar}'  connection  between  a  high  palate  and 
the  degree  of  mental  capacity  of  the  individual." 

Dr.  Clay  Shaw  believed  that  a  high  palate  is  invariably 
associated  with  narrow,  pterygoid  width,  and  a  narrow 
skull,  but  this  theory  is  of  little  value.  By  a  close  examina- 
tion of  the  vaults  of  the  dolichocephalic  heads,  it  will  be  seen 
that  such  is  not  the  case,  but  that  they  are  also  to  be  seen 
among  the  brachycephalic  and  mesocephalic  heads. 

Cuylitz,f  a  Belgian  authority,  accepting  the  views  of 
Langdon  Down,  and  others,  as  to  the  connection  of  a  high- 
vuulted  palate  with  mental  deficiency,  explains  it  as  follows: 
"  The  brain  tends  to  develop  transversely,  but  it  meets  in 
some  cases  a  resistance  in  the  parietal  region  which  crowds  it 
back.  This  pressure,  transmitted  by  the  zygomatic,  tem- 
poral and  molar  processes,  pushes  together  the  alveolar  bor- 
ders of  the  superior  maxilliaries  like  a  workman's  tongs,  the 
approximation  of  the  main  branches  of  which — that  is,  of  the 
parietals — brings  the  ends  together,  the  hinge  being  repre- 
sented by  the  body  of  the  sphenoid,  and  the  occipital.  This 
bringing  together,  therefore,  of  the  alveolar  borders,  or  the 
original  palate,  is  only  the  expression  of  a  cerebral  collapse 
or  abnormal  effort,  which  in  the  psychic  life  reveals  itself  by 
degeneracy." 

The  advantages  of  a  law  like  the  above  are  obvious,  pro- 
vided always  that  it  is  a  definitely  established  one.  Even 
for  a  working  hypothesis  a  certain  amount  of  substantiating 
evidence  is  needed,  and  this  cannot,  it  seems  to  me,  be  consid- 
ered as  yet  as  anything  more  than  an  ingenious  suggestion, 
which,  however,  is  worthy  of  consideration. 

THUMB-SUCKING   AND   SIMILAR   CAUSES   PRODUCING   HIGH 
FAULTS. 

y       As  early  as  1834,  J.    Imrie   stated,  in  Parents'   Dental 
^  Guide,  that  "  rabbit-mouth  is  due  to  keeping  the  thumb  in  the 

*  Journal  of  Mental  Science.  -July.  1876. 

t  Quoted  by  Regis.  Mental  Medicine,  2d  Edition,  Paris,  1891. 


THE     HEAD,    FACE,    JAWS    AND   TEETH  329 

mouth  for  hours  after  ^oing  to  sleep."  Since  this  time  differ- 
ent authors  have  asserted  that  thumb,  finger,  lip,  tongue  and 
sugar-teat  sucking  arc  the  cause  of  the  high  or  deformed 
vault. 

When  we  consider  the  size  of  the  vault,  especially  its 
antero-posterior  diameter,  and  compare  it  with  above-named 
articles,  it  would  seem  absurd  to  suppose,  for  a  moment,  that 
there  was  any  comparison  in  size  between  the  two,  or  that  a 
depression  made  by  any  one  of  these  agencies  could  produce 
uniform  width  and  height  throughout  the  entire  length  of 
the  vault. 

Children  commence  to  suck  their  fingers  soon  after  birth, 
and  as  absorption  and  deposition  of  bone  cells  take  place 
faster  at  this  time  than  at  any  other  in  the  life  of  the  individ- 
ual, one  would  naturally  expect  to  find  high,  narrow  vaults 
in  connection  with  the  first  set  of  teeth  or  before  the  sixth 
year;  but  such  is  not  the  case.  We  frequently  find  children 
sucking  their  fingers  who  have  verv  low  vaults. 

Dr.  Thomas  Ballard  read  a  paper  on  the  "Constitutional 
Ill-eflfects  of  Fruitless  Sucking,  and  the  Diagnostic  Value  of 
Deformed  Jaws  in  Relation  Thereto,"  before  the  Odontologi- 
cal  Society  of  Great  Britain  in  1864,  in  which  he  said:  "  And 
as  in  idiots  are  seen  the  worst  forms  of  defective  growth,  so 
also  do  they  exhibit  the  most  aggravated  forms  of  deformed 
jaws  and  teeth;  the  habit  of  sucking  being  retained  by  them 
to  an  advanced  age." 

I  think  1  am  correct  in  stating  that  there  are  very  few,  if 
any,  gentlemen  connected  with  schools  of  idiocy  who  agree 
with  Dr.  Ballard  in  this  statement. 

I  am  prepared  to  state  that  there  are  no  more  deformities 
of  the  palates  among  idiots  than  there  are  to  be  found  among 
other  defective  classes.  The  worst  deformed  vault  and  dental 
arches  I  have  ever  observed  were  those  of  a  murderer,  sen- 
tenced for  life  in  the  Joliet  Penitentiary.  There  are  to  be 
found  among  normal  individuals,  such  as  seek  our  services  in 
our  offices,  just  as  marked  deformities  as  are  ever  observed 
among  the  inmates  of  our  schools  of  idiocy,  who  are  also 
known  not  to  suck  their  fingers.     The  attendants,  who  are 


330  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

constantly  watching  over  them  and  caring  for  their  welfare, 
would  be  very  likely  to  notice  if  such  vicious  habits  were 
being  practiced,  but  such  is  not  the  case. 

FALLACIES   OF   CLOUSTON'S   THEORIES. 

In  1891,  Dr.  T.  S.  Clouston  published  a  paper  in  the 
Dental  Hecord  wpon  "The  Hard  Palate  in  its  Relation  to 
Brain  Development,"  in  which  he  divided  the  vault  into  three 
groups.  The  first  he  calls  "Typical,"  or  "  Normal  "  (Fig. 
103,  No.  1).  It  corresponds  to  Ivy's  section  of  the  "  horse- 
shoe arch;"  the  low,  but  regular  wide  dome,  he  says,  is  char- 
acteristic of  the  sanguine  temperament.  The  second  he  calls 
the  "Neurotic"  (Fig.  103,  No.  2),  because  he  says  "The 
deformity  of  the  palate  occurs  du^ring  the  brain-growth  early 
in  life,  probably  in  utero. ' '  He  believes  that  it  is  a  "  bad 
initial  neurotic  heredity,"  just  as  we  refer  to  a  bad  type  of 
face  or  irregular  teeth,  or  an  asymmetrical  head  to  such  her- 
edity. The  third  class  he  calls  "  Deformed"  palate  (Fig.  103, 
No.  3).  It  is  of  various  shapes,  all  abnormal,  but  the  most 
common  form  is  very  high,  narrow,  and  at  the  top  either  V 
or  saddle-shaped  on  account  of  the  shoulder  on  each  side  of 
the  teeth,  he  had  described. 

While  there  is  a  certain  amount  of  truth  in  the  arguments 
used  for  the  names,  as  we  §hall  see  later,  he  does  not  quite 
take  in  the  situation.  The  terms  "Normal,"  "Neurotic," 
and  "  Deformed"  hardly  define  the  conditions  of  the  vaults. 
Thus,  a  normal  jaw  may  contain  a  vault  ranging  all  the  way 
from  .21,  the  lowest  I  have  ever  seen,  to  .88,  the  highest,  and 
all  in  a  perfectly  normal  condition.  If,  then,  a  normal  arch  is 
like  the  horseshoe  arch  of  Ivy's,  what  shall  we  call  a  normal 
arch  that  is  .25  of  an  inch  higher  or  lower?  The  neurotic 
arch,  he  says,  "is  more  of  a  Gothic  arch,  with  the  alveoli 
tending  to  run  more  parallel  and  narrow  down,  the  roof  of 
which  is  formed  by  a  larger  part  of  a  smaller  circle." 

I  have  observed  neurotic  arches  very  high  and  narrow, 
high  and  broad,  low,  and  both  narrow  and  broad,  with  marked 
neurotic  jaws,  face  and  head. 

The  third  class,  which  he  terms  "Deformed,"  compose 


THE    HEAD,    FACE,    JAWS   AND    TEETH 


331 


Clou5to7i'5  CIa55ificqlTon 


N<rurotic . 


Deformeo . 


Fig.  103. 


332  ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 

the  V  and  saddle  jaws.  We  shall  see  later  that  Clouston  does 
not  quite  grasp  the  situation.  Instead  of  reasoning  himself, 
he  allows  himself  to  be  carried  away  by  the  absurd  theories 
of  others.  We  shall  see  later  that  what  he  termed  a  deformed 
jaw  is  nothing  more  nor  less  than  a  neurotic  condition,  and 
that  the  deformed  and  neurotic  are  one  and  the  same. 

Clouston  uses  the  same  argument  that  J.  Langdon  Down 
did  in  1871,  and  Cole  in  1881,  that  "excessive  vaulting  of 
the  palate  is  due  to  arrest  of  development  of  the  sphenoid 
bone,"  and  "  premature  ossification  of  the  suture  at  the  base 
of  the  skull."  He  says,  "in  considering  the  palate  and  upper 
maxillary  bone,  one  must  take  into  account  the  following 
considerations,  viz. :  Its  relations  to  the  base  of  the  skull  in 
man.  This  relation  is  seen  to  be  close  and  absolute  as  com- 
pared with  the  lower  animals. 

"  If  a  perpendicular  line  be  drawn,  marking  the  most  anter- 
ior point  of  the  brain,  it  is  seen  to  fall,  in  man,  through  the 
center  of  the  hard  palate,  while  in  the  monkey  it  only  just 
touches  its  posterior  margin. 

"  In  man  it  thus  has  a  direct  relationship  to  the  brain  base, 
and  its  shape  would  be  dominated  by  the  width  of  this;  while 
in  the  monkey  it  is  nearly  a  part  of  the  alimentary  system, 
having  little  relationship  to  the  base  of  the  brain  at  all.  No 
one  can  compare  the  two  without  seeing  that  its  conformation 
in  man  will  naturally  follow  any  changes  that  take  place  dur- 
ing development  in  the  skull-base. 

"  If  the  skull  in  its  growth,  size,  shape,  dome  and  base,  is 
absolutely  dominated  by  the  brain  it  contains,  and  on  which  it 
depends,  then  the  brain-growth  will,  in  this  way,  second- 
arily determine  the  shape  of  the  upper  maxillary  bone  and 
palate." 

I  have  quoted  this  part  of  Clouston's  paper,  because 
anthropologists  invariably  use  this  as  one  of  the  points  in 
favor  of  the  theory  of  the  evolution  of  man,  but  I  have  never 
been  able  to  see  what  relation  the  jaws  and  vault  had  to  the 
base  of  the  brain,  or  how  any  force  directed  by  the  sphenoid 
bone,  through  the  vomer  (if  it  were  possible),  could  in  any 
way  affect  the  vault  or  shape  of  the  jaw. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  333 

If  the  intervening  space  between  the  base  of  the  brain  and 
the  vault  were  solid,  I  could  easily  see  how  a  change  in  the 
shape  of  one  might  exert  an  influence  upon  the  other.  The 
space  occupied  by  the  nares  being  located  between  the  two, 
with  the  two  strong  pillars  of  the  superior  maxillary  bone 
upon  either  side  as  a  resistance,  to  my  mind  precludes  such  a 
theory.  The  fact  that  the  jaw  has  become  less  normal,  or  that 
the  anterior  lobes  of  the  brain  have  developed  and  become 
more  prominent,  would  lead  me  to  believe  in  a  general  way 
that  the  roof  of  the  mouth  should  be  less  vaulted,  or,  in  other 
words,  the  base  of  the  skull,  which  is  situated  above  the  vault, 
instead  of  posterior  to  it,  would  occupy  much  of  the  space 
necessary  for  the  anterior  and  posterior  nares,  thus  crowding 
down  the  vault.  That  any  force,  produced  by  the  develop- 
ment of  the  bones  at  the  base  of  the  skull,  or  early  or  retarded 
ossification  of  suture  in  that  locality,  could  exert  any  influ- 
ence through  the  vomer,  to  my  mind  is  not  well  taken.  The 
fact  that  the  vomer  does  not  ossify  until  puberty,  the  thinness 
of  the  bone,  after  ossification  has  taken  place,  and  that  it  is 
most  always  crimped  or  deflected  in  one  direction  or  another, 
would  be  conclusive  proof  that  no  efiect  could  be  produced 
upon  a  vault  of  bone  supported  by  the  anterior  alveolar  pro- 
cess, and  with  a  rib  or  suture  extending  its  entire  length,' 
which  ossified  years  before  any  changes  in  the  vault  were 
noticed.  We  frequently  observe  the  ridge  and  the  two  vaults, 
one  on  either  side,  extend  anteriorly  through  the  alveolar 
process  nearly  or  quite  to  the  incisor  teeth.  No  one  would 
think  for  a  moment  that  the  vomer  could  exert  any  influence 
upon  the  palate,  either  up  or  down,  through  the  maxillary 
bone  and  alveolar  process.  If  the  argument  were  true,  the 
vomer,  before  it  could  draw  up  the  vault,  would  necessarily 
have  to  be  drawn  taut,  but  we  rarely  observe  such  a  condition, 
although  the  high  vaults  are  numerous. 

Clouston  says,  further  on  in  his  paper:  "Those  palates, 
where  the  deformity  consists  in  a  ridge  down  the  center, 
antero-posteriorly,  seem  to  show  that  in  them  the  deformity 
took  place  at  a  later  period  than  in  other  deformed  palates 
where  the  nasal  septum  was  getting  stronger  and  kept  the 


334  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 

center  of  the  palate  down,  while  on  each  side  of  it,  the  palate 
was  drawn  up,  making  two  vaults,  side  by  side,  instead 
of  one." 

This  theory,  however,  is  not  correct.  I  have  frequently 
observed  this  deformity  in  the  center  of  the  vault  as  early  as 
the  second  year,  or  at  the  time  of  ossification.  If  his  theory 
is  correct,  that  the  contraction  at  the  base  of  the  skull,  pro- 
ducing pressure  through  the  vomer,  causes  the  high  vault, 
and  when  ossification  of  the  vomer  stops  this  procedure  what 
carries  up  the  sides  of  the  vault?  Again,  in  such  cases  the 
vomer  would  be  perfectly  straight,  which  is  not  observed  in 
such  cases. 

Clouston  reiterates  a  statement  which  has  been  made 
many  times,  that  "the  deformity  of  the  palate  (which,  of 
course,  must  include  the  jaw)  occurs  during  brain-growth, 
early  in  life,  probably  in  utero.''''  This  theory  can  hardly  be 
based  upon  a  sound  hypothesis,  for  the  reason  that  the  brain 
continues  to  grow  until  the  seventh  or  eighth  year.  We  shall 
see  later  that  the  vault  does  not  change  very  much  in  height 
till  after  the  sixth  or  eighth  year;  therefore  a  high  vault  can- 
not be  said  to  develop  early  in  life,  much  less  in  utero. 

THE    VAULT   IN    ITS    RELATION    TO    TEMPERAMENTS. 

Dr.  Robert  S.  Ivy,  in  The  American  System  of  Dentistry., 
in  the  article  "Dental  and  Facial  Types,''  looks  on  them  as 
being  part  of  the  morphology  of  the  temperaments.  He  says: 
"The  shape  of  the  alveolar  arch  and  the  dome  of  roof  of  the 
mouth,  also  the  articulation  of  the  teeth,  and  the  manner  in 
which  the  gum  is  festooned  over  each  tooth,  are  all  indicative 
of  the  several  temperaments,  and  present  varieties  worth 
attention.     [Illustrated  in  Fig.  104.] 

"The  arch  of  the  bilious  temperament,  from  cuspid  to 
cuspid,  is  almost  flat,  the  lines  backward  from  these  points 
slightly  diverging  in  an  almost  straight  line.  The  dome  of 
the  mouth  is  high  and  almost  square.  When  articulated,  the 
upper  central  incisors  overlap  the  lower,  and  are  closely 
locked.  In  general  form  the  teeth  are  large,  the  corners 
tending  to  squareness,  and  are  rather  long  in  proportion  to 


THE    HEAD,    FACE,    JAWS    AND    TEETH  335 


Ivys  dqs^ification. 
Bilious. 


Sanguinary: 


Fig.  104. 


'Sanguinary  should  be  sanguine. 


336  ETIOLOGY  OF   OSSEOUS  DEFORMITIES    OF 

their  breadth:  in  texture  they  are  dense  and  strong.  The 
proximal  surfaces  arc  in  close  contact  two-thirds  of  the  dis- 
tance from  the  cutting  edge  to  the  neck,  rendering  the  festoon 
of  the  gum  short  and  heavy. 

"The  sanguine  arch  resembles  a  horseshoe  in  shape.  The 
dome  of  the  mouth  is  high  and  semi-circular.  The  articula- 
tion of  the  teeth  is  close  and  firm,  and  their  structure  is  dense. 
The  masticating  surfaces  of  teeth  in  this  class  frequently  bite 
edge  to  edge,  and  as  age  advances  they  are  gradually  worn 
down  to  the  gum  unless  protected  by  artificial  means.  In 
general  form  they  are  well  proportioned,  length  predomi- 
nating in  less  degree  over  breadth,  and  their  outlines  are 
rounded  and  curved.  The  distal  and  mesial  surfaces  are  in 
contact  a  little  more  than  half  the  distance  from  the  cutting 
edge,  and  the  festoon  is  long  and  delicate  in  outline. 

"The  arch  of  the  nervous  temperament  presents  a  strong 
contrast  to  either  of  the  two  preceding,  and  is  sometimes 
spoken  of  as  Gothic,  from  its  pointed  character.  From  the 
central  incisors,  which  often  overlap  for  want  of  space,  the 
line  of  the  remaining  teeth  continues  backward  with  a  slight 
curve,  the  greatest  prominence  being  between  the  cuspid  and 
the  first  bicuspid.  The  roof  of  the  mouth  partakes  of  the 
same  curve  and  angle  as  the  arch.  The  articulation  of  the 
teeth  is  not  close  but  long,  and  the  teeth  belonging  to  this 
temperament  are  of  average  density  and  structure.  In  shape, 
length  predominates  over  breadth;  the  distal  corner  of  the 
centrals  is  rounded,  giving  the  whole  tooth  almost  the  appear- 
ance of  a  lateral,  and  the  cusps  and  cutting  edges  are  long 
and  fine.  The  point  of  contact  of  the  proximal  surfaces  is 
near  the  cutting  edge,  giving  a  long,  delicate  festoon  to  the 
gum. 

"The  lymphatic  arch  is  almost  semi-circular  in  its  outline, 
and  somewhat  resembles  that  of  the  sanguine  temperament. 
The  dome,  or  roof  of  the  mouth,  is  flat  and  low.  The  articu- 
lation is  irregular,  and  the  front  teeth  are  apt  to  protrude. 
In  shape,  breadth  predominates  over  length,  and  the  normal 
depressions  and  elevations  are  either  entirely  absent  or  unde- 
fined.    The  festoon  of  the  gum  is  thick  and  indefinite  in  out- 


THE     HEAD,    FACE,    JAWS   AND   TEETH  337 

line.  The  lateral  on  either  or  both  sides  is  frequently  out 
of  line." 

This  classification  would  seem  on  general  principles  to 
possess  some  merit,  but  upon  close  observation  it  will  not 
hold  good. 

The  temperament,  as  far  as  the  shape,  size  and  character 
of  the  jaws  and  teeth  are  concerned,  has  nothing  whatever  to 
do  with  it,  and  the  vault,  least  of  all,  cannot  share  in  any  such 
division. 

In  mouths  of  the  bilious,  sanguine,  nervous  or  lym- 
phatic temperaments  we  can  find  dental  arches  in  each  tem- 
perament measuring  2.50  across  from  the  inner  surface  of  one 
second  bicuspid  to  the  inner  surface  of  the  other.  We  can 
also  find  the  dental  arch  ranging  all  the  way  down  to  .96  in 
width,  and  the  antero-posterior  diameter  ranging  from  1.86 
to  2.43.  The  vaults  must  necessarily  range  in  height  and 
shape  to  correspond  to  the  width  and  length  of  the  dental 
arch. 

It  is  easy  to  see  why  temperament  has  very  little  to  do 
with  the  shape  of  the  dental  arch.  Two  individuals  are  mar- 
ried, one  a  nervous,  the  other  a  lymphatic,  bilious,  or  san- 
guine temperament;  the  oflFspring  inherits  the  jaws  of  one^ 
the  teeth  of  the  other,  and  the  temperament  of  the  child  is 
changed.  The  local  condition  is  such  that  the  shape  of  the 
jaw  may  change  the  character  of  the  vault  entirely.  One  child 
may  possess  a  broad  dental  arch,  but  very  short,  another  a 
very  narrow  and  long  dental  arch.  Hence,  classifying  the 
dental  arch  and  vault  with  temperament  is  wholly  out  of  the 
question. 

That  it  may  not  seem  presumptuous  on  my  part  to  advance 
such  positive  assertions,  let  us  examine  the  individuals  from 
which  the  following  drawings  were  taken  and  compare  the 
temperaments  with  the  antero-posterior  and  lateral  outlines. 

In  selecting  the  temperament  I  was  governed  by  the 
description  of  each  as  laid  down  in  the  article  by  Ivy  in  The 
American  System  of  Dentistry.  I  did  not,  however,  rely 
entirely  upon  my  own  judgment,  but  called  to  my  assistance 
a  physician  of  standing  and  ability. 


338  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

Under  the  heads  brachycephalie,  mesocephalic  and  doli- 
chocephalic, there  are  sixty  drawings  (Plates  19  to  28)  from 
models  of  white  individuals.  The  height  of  vault  varies  from 
.31  to  .81,  with  a  width  from  1  to  1.86;  the  antero-posterior 
ranges  from  l.ST  to  2.50. 

In  examining  the  drawings,  in  outline,  they  are  as  diflfer- 
ent  as  it  is  possible  to  make  them  and  not  produce  a  deformity. 
Thus,  in  the  antero-posterior  direction.  Figs.  1  and  7  (Plates 
19  and  21),  brachycephalie,  with  only  a  difference  of  .03  in 
width  of  head,  has  its  highest  part  in  the  vault  about  the 
second  molar,  while  Fig.  6  (Plate  19)  has  its  highest  at  the 
first  and  second  bicuspids.  Fig.  6  (Plate  23),  mesocephalic, 
has  its  highest  part  midway  between  the  highest  part  of 
Figs.  6  and  7,  brachycephalie. 

Looking  at  the  lateral  outline  we  notice  that  Figs.  1,  2 
and  6  (Plate  20),  brachycephalie,  are  pinched  or  contracted, 
and  this  contraction  is  not  uniform  upon  both  sides.     Figs. 

3  and  7  (Plates  20  and  22),  brachycephalie,  and  Fig.  6  (Plate 
21:),  mesocephalic,  are  broad;  Figs.  3  and  7  are  not  uniform 
upon  both  sides,  while  the  teeth  do  not  stand  in  the  same 
direction — some  stand  vertical,  others  at  an  angle  of  45°. 

Figs.  11  and  12  (Plate  22),  brachycephalie;  Figs.  1,  3  and 

4  (Plate  24),  mesocephalic,  and  Figs.  4  and  5  (Plate  27), 
dolichocephalic,  are  sanguine. 

Could  there  be  a  greater  difference  possible  in  comparing 
the  antero-posterior  and  lateral  drawings?  Fig.  12  (Plate 
22),  is  very  high  at  the  middle,  or  about  the  first  permanent 
molar,  while  Fig.  4  (Plate  23),  mesocephalic,  and  Fig.  4 
(Plate  27),  dolichocephalic,  are  very  flat,  and  the  soft  palate 
of  Fig.  4  (Plate  27),  dolichocephalic,  extends  back  consider- 
ably farther  than  in  Fig.  4,  mesocephalic. 

Figs.  1,  3,  5  and  11  possess  graceful  curves,  but  not  on  the 
same  circle.  The  teeth  also  stand  at  different  angles,  as  in  the 
last  group.  In  looking  over  the  lateral  drawings.  Fig.  4,  meso- 
cephalic, and  Fig.  5,  dolichocephalic,  possess  a  slight  resem- 
blance, although  the  width  and  height  vary  .12  and  .31  of  an 
inch,  respectively.  The  lowest  vault  has  the  widest  jaw, 
while  the  highest  vault  the  narrowest.     There  is  a  depression 


THE    HEAD,    FACE,    JAWS    AND   TEETH  339 

at  the  median  line,  which  is  quite  marked,  in  the  antero- 
posterior drawing,  Fig.  4,  mesocephalic,  that  is  not  in  the 
other.  The  sides  of  the  arch  in  Fig.  4,  mesocephalic,  diverge 
to  a  greater  extent  than  those  in  Fig.  5,  dolichocephalic. 
Thus  in  a  general  way  no  two  resemble  each  other. 

It  is  claimed  by  some  that  the  neurotic  possess  the  high- 
est vaults.  Let  us  see  how  far  this  can  be  carried  out.  Figs.  8, 
9 and  10,  brachy cephalic;  Figs.  2,  7 and  10,  mesocephalic;  Figs. 
1  and  6,  dolichocephalic,  possess  a  nervo-bilious  or  neurotic 
temperament.  We  have  the  extreme  highest  vault .  76,  and  the 
extreme  lowest  .  37.  In  the  lateral  measurement  the  extreme 
narrowest,  1,  and  the  extreme  widest,  2.50.  As  far  as 
the  shape  of  the  dental  arch  and  teeth  are  concerned,  my 
observation  does  not  correspond  with  Ivy's  in  the  least 
degree. 

To  illustrate  the  wide  difference  in  two  individuals  of  the 
same  temperament,  let  us  take  Figs.  3  and  4,  mesocephalic 
— both  medical  students,  and  of  sanguine  temperament. 
Fig.  3  weighs  195  pounds,  is  six  feet  two  inches,  while  Fig.  4 
weighs  163^  pounds,  and  is  five  feet  eight  inches.  Both 
measure  seventy-nine  lateral ,  index.  The  two  heads  are 
exactly  alike.  The  width  of  vault  in  Fig.  3  is  1;  Fig.  4,  1.37. 
Height  of  vault  Fig.  3,  .56;  Fig.  4,  .50.  The  smaller  man 
possesses  the  widest  and  lowest  arch.  The  shape  of  the  den- 
tal arch,  the  gums  and  teeth,  are  wholly  unlike.  The 
smaller  man  has  the  larger  teeth,  while  the  gums  are  long 
and  pointed.     The  larger  man  has  short,  broad  gums. 

There  were  only  three  lymphatic  individuals.  Fig.  5 
(Plate  20),  brachy  cephalic;  Fig.  9  (Plate  26),  mesocephalic, 
and  Fig.  3  (Plate  27),  dolichocephalic.  Fig.  5  possesses  height 
of  vault,  .62;  Fig.  9,  .44;  and  Fig.  3,  .75;  while  the  width  of 
vault  is.  Fig.  5,  1.25;  Fig.  9,  1,  and  Fig.  3,  1.25. 

In  looking  over  the  drawings,  I  find  none  resembling 
Ivy's  illustrations,  nor  do  any  look  alike.  It  will,  therefore, 
be  noticed  that  the  same  rule  holds  good  in  the  lymphatic 
temperament  as  in  all  others,  that  there  is  no  uniformity  in 
shape,  size  or  height. 


340  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

SHAPE    OF   THE    ^  AULT    COMPAKED    WITH    THE    SHAPE    OF    THE 

HEAD. 

It  has  been  stated  that  the  shape  of  the  vault  resembles 
the  shape,  or  contour,  of  the  head.  Thus  a  l)rachycephalic, 
or  broad  head,  contains  a  large,  broad  jaw  with  a  low  vault, 
while  a  dolichocephalic,  or  long,  narrow,  high  head,  pos- 
sesses a  long,  narrow  jaw  with  a  high  vault.  In  order  to 
study  the  relation  of  the  shape  of  the  vault  with  the  contour 
of  the  head,  a  large  number  of  models  were  secured,  and 
measurements  of  the  head  taken.  The  shape  of  the  jaws 
were  taken  in  modeling  compound  in  such  a  manner  that  the 
soft  palate  could  also  be  outlined.  From  these  impressions 
plaster  models  were  obtained,  measurements  then  taken,  and 
the  models  sawed  at  the  median  line.  One  half  was  placed 
upon  paper  and  an  outline  obtained.  The  two  halves  were 
then  glued  together  and  the  saw  passed  through  the  model 
laterally  between  the  second  bicuspid  and  first  permanent 
molar.     The  anterior  half  was  then  outlined. 

The  shape  of  the  head  was  obtained  by  the  use  of  a  heavy 
strip  of  lead  carefully  moulded  to  the  head  in  the  antero- 
posterior direction  from  the  nose  to  the  l)ase  of  the  skull,  then 
removed,  laid  upon  paper,  and  outlined.  The  lateral  contour 
was  obtained  by  moulding  the  lead  over  the  head,  just  back 
of  the  ears.  These  outlines  were  reduced  by  means  of  the 
pantagraph  to  about  one  third  the  natural  size.  Unfortu- 
nateh'',  craniologists  are  not  yet  in  accord  as  to  the  best 
method  of  taking  the  measurement  of  the  head.  This  want 
of  harmony  precludes  uniformity  of  action  in  deciding  what 
shall  constitute  a  broad  head  and  a  long  head. 

Vogt  says,  in  his  work  on  man:  "Taking  the  tables  of 
Welckeras  a  basis,  and  assuming  the  longitudinal  diameter  of 
the  skull — 100,  the  following  results  are  obtained  for  the 
various  races;  where  the  mean  of  the  transverse  diameter  is 
below  72,  they  may  be  termed  long  heads;  where  it  exceeds 
81,  short  heads;  where  it  varies  between  74  and  SI,  middle 
heads. ' ' 


THE    HEAD,    FACE,    JAWS   AND   TEETH  341 

BROCa's    division  (FRENCH). 

1.  True  dolichocephalic,  -     below  750. 

2.  Sub -dolichocephalic,  -  750  to  778. 

3.  Mesocephalic,              -  -     778  to  800. 

4.  Sub-brachy cephalic,  -  800  to  833. 

5.  True  brachycephalic,  -  -     above  833. 

Professor  Flower,  of  the  Royal  College  of  Surgeons, 
England,  simplifies  this  table  by  the  following: 

Dolichocephalic,    -  -  -     below  750. 

Mesocephalic,  -  -  750  to  800. 

Brachycephalic,      -  -  -     above  800. 

I  adopted  the  rule  of  Flower,  for  the  reason  that  the  dif- 
ference between  the  broad  heads  and  the  long  heads  is  more 
pronounced.  I  could  more  easily  distinguish  any  deviation 
that  might  exist  between  the  vault  and  the  shape  of  the 
head. 

This  measurement  was  also  taken  with  the  instrument  used 
by  hatters.  I  found  it  of  no  value,  however,  except  to  give 
an  outlined  demonstration  of  the  shape  of  the  circumference 
of  the  head.  I  secured  models  and  measurements  of  the 
heads  of  white  and  colored  persons,  so  that  I  might  note  any 
deviation  in  the  shape  of  the  heads  of  the  two  races,  should 
there  be  any,  and  for  another  reason  which  I  shall  explain 
further  on.  I  found  it  very  difficult  to  pick  out  individuals 
possessing  brachycephalic,  mesocephalic,  and  dolichocephalic 
heads;  that  is,  I  could  not  decide  until  the  measurement  of 
the  head  was  taken,  whether  it  was  a  proper  case  or  not.  I, 
therefore,  invariably  took  the  measurement  of  the  head  first. 

It  may  seem  an  easy  matter  to  secure  individuals  with 
lateral  indexes  below  70,  or  long  heads,  especially  among  col- 
ored people,  since  they  have  been  classed  by  craniologists  as 
a  long-headed  race,  but  when  I  state  that  I  spent  my  noon 
hour  for  over  three  months  visiting  the  hotels  and  restaur- 
ants in  Chicago  with  a  view  of  securing  twelve,  and  was  only 
able  to  obtain  six,  we  can  have  some  idea  of  the  scarcity  of 
these   persons.       When   they   were    found,  it  required  the 


342  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

greatest  amount  of  tact  to  get  them  to  come  to  my  office  for 
the  examination,  owing  to  their  sensitive  nature. 

It  is  a  singular  fact  that  the  dolichocephalic  head  of  the 
negro  has  been  changed  in  this  country  to  a  mesocephalic  and 
even  brachycephalic  head  by  climate,  soil  and  the  mixture  of 
white  and  Indian  blood.  Hundreds  of  heads  measurinsf  over 
75  could  be  found,  when  only  one  below  70  was  obtained.  To 
find  white  dolichocephalic  heads  was  still  more  difficult.  I 
have  sufficient,  however,  for  the  purpose  which  required 
them.  The  children  were  classified  according  to  their  ages, 
and  in  most  cases  with  the  broad  heads  at  the  top  of  the  list. 
This  plan,  however,  was  not  always  carried  out,  but  by 
referring  to  the  lateral  index  number,  they  can  easily  be  com- 
pared. We  could  hardly  expect  to  find  a  uniformity  between 
the  contour  of  the  vault  and  the  head  (if  such  a  thing  were 
possible)  before  the  twelfth  year,  because  both  head  and 
vault  are  undergoing  the  formative  process.  They  are  given, 
however,  for  the  purpose  of  showing  the  changes  that  do 
take  place  in  the  transitory  period. 

Below  is  given  a  description  of  the  diagram  of  the  shapes 
of  the  vaults  of  forty-eight  adults,*  white  and  colored;  twelve 
brachycephalic  (Plates  19,  20,  21  and  22);  twelve  mesocephalic 
(Plates  23,  24,  25  and  26);  six  dolichocephalic  (Plates  27 
and  28),  white;  and  six  brachycephalic,  six  mesocephalic  and 
six  dolichocephalic  (Plates  29  to  34),  colored.  The  index 
width  outside  first  permanent  molar,  width  outside  second 
bicuspid,  width  inside  second  bicuspid,  antero -posterior 
measurement  when  the  third  molar  was  present,  height  of 
vault,  and  temperament  were  noted. 

The  special  instruments  already  described  were  used  for 
the  last  two  measurements,  for  the  reason  that  in  the  antero- 
posterior measurement  frequently  only  one  third  molar  was 
present,  or  a  tooth  anterior  to  the  third  molar  might  have 
been  extracted,  in  which  case  the  third  molar  upon  that  side 
would  have  moved  forward.  In  such  case  the  T-square  (Fig.  10) 
when  placed  upon  the  posterior  surface  of  the  furthermost 
third  molar,  and  the  long   arm  brought  forward   to  a  point 

■*  The  shapes  of  the  heads  were  taken,  but  are  not  illustrated  in  this  work. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  343 

between  the  central  incisors,  a  very  accurate  measurement 
could  then  be  obtained.  The  vault  varies  so  much  in  height 
at  different  localities  that,  in  order  to  obtain  the  measure 
ment  at  the  highest  part,  it  was  necessary  to  invent  an  instru- 
ment that  could  be  moved  backward,  forward  and  at  any 
angle,  in  order  that  these  points  could  be  reached,  and  at  the 
same  time  have  a  fixed  point  (the  alveolar  process  between 
the  second  bicuspids  and  first  permanent  molars)  to  start 
from. 

The  instrument  is  illustrated  in  Fig.  11.  The  figures  1, 
2,  3,  etc.,  together  with  the  same  figures  of  antero-posterior 
and  lateral  diameter  of  the  mouth,  correspond  to  the  same 
individual;  upon  close  examination,  there  is  not  the  slightest 
resemblance  between  them.  Occasionally,  by  a  stretch  of  the 
imagination,  we  think  that  we  can  discover  a  slight  simi- 
larity, but  upon  a  critical  examination  there  is  no  resem- 
blance. Let  us  now  examine  the  extreme  in  the  brachy- 
cephalic  (Plates  19,  20,  21  and  22)  and  dolichocephalic  (Plates 
27  and  28). 

If  we  cannot  find  a  uniformity  in  the  vault  and  contour  of 
the  heads  of  these  individuals,  we  certainly  cannot  expect  to 
find  them  in  the  mesocephalic  individuals  (Plates  23,  24, 
25  and  26). 


344 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


TEMPERAMENT. 

Nervo-sanguine 

Nervo-sanguine 

Nervo  sanguine 

Nervo-bilious 

Lympho-sanguine 

Sanguino-bilious 

Nervo-sanguine 

Nervo-bilious 

Nervous 

Nervous 

Sanguine 

Sanguine 

HEIGHT    OF 
VATJLT. 

1 

l~   ~    ~    ~l   -f   -t   ^   Ct   ~.   T!  -f   I- 
—  I-  I-  71  l-  I-  I-  71  rc  c>  t-  ti 

Z:  Z:  Ia  Z '^ '^  Zl  Z -'  ^ '^  iz 

In. 

0.44 
0  50 
0 .  50 
0.56 
0.G3 
0.(52 
0 .  50 
0.56 
0..37 
0 .  56 
0 .  (52 
0 .  68 

ANTERO-P  O  9- 
TERIOR. 

1 

~.  -r  ~     •  -f  ir:  I-  -^     •  -z>  ^r.  ^ 

t-  ro  O     •  CO  [~-  ir:  t-     •  CO  f~  fo 
-*  ir:  o     .  ic  m  1.'^  Tfi     .  co  u'^  m 

I— I 

I-  C!  I-      ■  'T^  lO  CO  I-      •  O  t~.   C! 

QO^CO       ■i-IC!r-ICC       •  iO  <Tt  -^ 

T^  01  C-1       •  «  CJ  C^J   rH       .  OJ  CJ  CI 

WIDTH    BE- 
TWEEN   2d 
BICUSPIDS 

L-  u-  I-  ir:  in  o  t-  I:-  05  O  c>  O 
l-  I-  I-  L-  i-  -*  c-  iM  o:  •*  w.  l- 

CO  CO  CO  CC  CO  W  CO  fO  Ul  O"!  O  T} 

0  1.0   t-  l-O   LO    O   t-  -H   ■—    O   '^   C! 

01  I'J  CO  CI  OJ  O  CO  CO  O  O  O  — ' 

o  a  m 

g  02   O 

a 

-t<  ~  Si  C-  C".  l-O  -+  ~.  ~.  lO  c  o 

CO  t-  O  I-  I-  't*  CO  t-  L-  >*  £-  O 
UO  -rt*  -O  "*  '^  '^i   l-O  ^  -^  ^  '^  1-0 

0!  I-  I-  !.-  I-  '-0  Oil-!-  i.O   I-  O 

^  GO  CO   Xl  CO   I-  T-H  CO  CO  I-  C/D   o 

^-.    rt    CJ    rt    ^    ^    Ci    ^    -<    r-4    ^    O! 

B  o 

CQ 

S 

i-HOOi-OXi-HaDi-HGOaoGOaDT-H 
OcoOCOOcoOOfOOOl- 

o  Lo  '.o  o  o  LO  '^  LO  Lo  uo  m  lo 

I— I 

t-  C>  Ti  CI  t-  CI  t-  O  CI  O  O  i-O 

COt-ICJi-ICOtHCOO'-HOOC"! 

71  a  Cl  Cl  Cf  01  CI  CJ  CI  C!  CI  c^ 

g                         X«Xa)X»-CCXlGOGOGOCC 

M 

d 

i 

-H  05  CO  -t<  lO  O  t-  CO  o;  O  ^  ?J 

1 

THE     HEAD,    FACE,    JAWS   AND   TEETH 


345 


H 
H 

3 

_0 

'3  6 

l/2  ^ 

Sanguine 

Sanguine 

Nervous 

Nervo-sanguine 

Nervo-bilious 

Nervous 

Lymphatic 

Nervo-bilious 

Neurotic 

Neurotic 

O 
H 

CI  h^ 

S 

oi  0  t- 
w  L-  a 

«  0  t-  t-  c"?  t-  0 

W  W  rH  rH  Cf  GO  I- 

-*    Tt< 

r*    CI    i> 

r^  -^   r-{ 

■*  Tfl   rH   rH  '^   L-  IM 
-H   rH    rH   rH   rH            T-l 

1— 1 

0  'IE 

0   0  CO 

in  in  0 

CO   0   Tt<   Tt<   CO   ^    0 

in  in  Tfi  -^  in  CO  in 

0  0 

000 

0000000 

O 

«  2 
g  S 

5^ 

S 

0    • 

CO      • 

.  in     • 

in     -in     •  0  0     • 

tH       •  rH       •  CJ  GO       • 

0    • 

■  in     • 

J>      .  !>      •  0  0      • 

in     -in     ■  CD  in     • 

fl 

0  • 

0    • 

•  in     • 

in     -in     •  r-  0     • 
CI     •  ci     •  CO  0     • 

(M      • 

•  ci 

w     •a     ■  M  oj     • 

CO        tn 

^S 

M  H  gj 

«  ^  g 
^  R  3 

t-  in 

05  r- 

0  Ci  05 
Thi  i-  OS 

03  !>  0  0  in  0  in 

c^  CO 

10  ■*  0 
C-1  CO  C-l 

r#  0  in  in  rH  in  rH 
CO  cj  c^)  c}  CO  M  CO 

CO  ifi 

0  t-  0 

0  cc  GO 

t-  CO  0  0  in  0  in 
CO  rH  0  0  cj  0  Ci 

1-1   i-( 

^    T-1    ^ 

rH   tH   ^   rH   rH   rH   rH 

p 

O    0    IE 

fi  B  ^ 

sag 

g  S  o 

a 

0    0 

00  oo 

in  in  in 

rH   rH   Tt< 

-*  0  0  in  ■*  in  0 
GO  cc  00  ■*  CO  ■<*i  00 

0  0 
in  w 

rH   J>   -^ 

^  in  -* 

CO  0  0  ^  CO  ^  0 
in  in  in  Tj<  m  r:t<  in 

d 

0  0 
0  0 

ci  in  in 

CD  (^3  t- 

w  0  0  in  C5  in  0 

rH  0  0  E-  rH  C-  0 

tH  W  rH 

C4  C5  C5  tH  CQ  iH  03 

H  6 

m 
H  S  K 

0  lO 
rH   rH 

0  0  Tt< 
GO  in  CO 

0  in  in  c3  0  0  t- 

CJ  rH  rH  CO  C3  00  CO 

in  »n 

0  CO  CO 

in  CO  in 

0  !>  !>  (TJ  0  0  m 

0  in  in  in  CO  in  in 

1—1 

>n  in 

0  0  w 

0   in   rH 

£>  in  in  CO  t-  0  00 

CO  03  C3  0  CO  0  i-H 

(Tj  :^5 

01  c-t  Cl 

W  C3  C3  M  C5  03  C3 

INDEX. 

C5   03 

0   05   GO 

I>  i>  J> 

GO  !>  j>  CD  0  in  in 

6 

rH   (M 

CO  ■*  in 

CO   t-   00   OS    0   rH   CO 

H 

PS 

m 

H 

Nervo-bilious 

Bilious 

Nevro-lymphatic 

Sanguine 

Sanguine 

Nervo-bilious 

0 

EH 

0  >^ 

M    U 

3 

m  -ti  m  m  m  l-- 
0  i.-  0  0  I-  0 

§ 

01  in  o>  C5  0  0 

rH  iH   rH  tH   C3  rH 

1— 1 

in  C3  in  in  rH  iT 
i-  CD  t~  r-  00  I- 

00000= 

02 

ft      . 

■      §2 

5^ 

a 

-+i  ^  £-  t-       - 

CO  00  CO  -o      • 

CO  CO  in  CO     • 
in  in  in  in 

1— 1 

C3  C3  CD  rH       . 
rH  rH   rH  CO       • 

CO  CC!  C*  OS       • 

m  0 

CD        m 

"  s  K 
2^2 

a 

0  in  in  ^  m  !> 

rH   I-  c-  in  t-  Cl 

GO    rH    rH    CO   rH    CO 

CO  CO  CO  CO  CO  CO 

d 

hH 

0  in  in  ^  in  i-H 
in  cj  CQ  -*  c3  CO 

0  0  tc 
w  0 

a 

■*  0  a:  0  Ci  0 

CO   00   Ttl   GO   Tj<   CO 

co'  d  !>  d  t-^  d 
i^  io  ^  if:  ^  i^ 

d 
1— 1 

C3   0  t-  0  £-  0 
iH   0  GO   0  GO   0 

C4   CJ   rH    C3   rH    C3 

^  2 

«a3 

a 

m  m  0  cs  CI  m 

rH    ^    00    rH    CO    rH 
E-  !>  0   0   C3  £- 

in  in  m  CD  in  in 

d 
1— 1 

m  m  0  c-  CD  m 

C3  C*  0  CO  0  OJ 
C3  C3  CJ  C3  C3  C3 

4 

INDEX. 

CJ  C3  C5   C3  -H  CD 
!>  C-  C-  i>  !>  CO 

6 

rH  c^3  CO  ■>*'  m  CD 

346  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

BRACHYCEPHALIC — COLORED. 


NO. 

INDEX 

WIDTH     O  TTT- 
SIDE  1st  mo- 
lab. 

WIDTH    OUT- 
SIDE   2d    BI- 
CUSPIDS. 

WIDTH    BE- 
TWEEN 2d 
BICUSPIDS. 

ANTERO- POS- 
TERIOR. 

HEIGHT    OF 
VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

1 

2 
3 
4 
5 
6 

87 
87 
85 
84 
84 
81 

2.87 
2.50 
2.37 
2.25 
2.50 
2.50 

72.90 
(53.50 
60.20 
57.15 
63., 50 
63.50 

2.00 
2.25 
2.00 
2.00 
2.12 
2.00 

50.80 
57.15 
50.80 
50.80 
53.84 
50.80 

1.31 
1.62 
1.37 
1.31 
2.50 
1.37 

33.27 
41.15 
34.77 
33.27 
63.50 
34.79 

2.18 
2.12 

2.00 
2.25 
2.25 

55.37 
53.84 

.50.80 
57.15 
57.15 

0.56 
0..50 
0.62 
0.75 
0  50 
0.75 

14.22 
12.70 
15.74 
19.05 
12.70 
19.05 

MESOCEPHALIC — COLORED. 


NO. 

INDEX 
80 

WIDTH    O  U  T- 
SIDE  IST  MO- 
LAR. 

WIDTH    OUT- 
SIDE   2d    BI- 
CUSPIDS. 

WIDTH    BE- 
TWEEN  2d 
BICUSPIDS. 

ANTERO- POS- 
TERIOR. 

H  E  I  G  HT    OP 

VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

1 

2.50 

63.50 

2.25 

57.15 

1.62 

41.15 

2.31 

58.67 

0.62 

15.74 

2 

79 

2.81 

71.37 

2.50 

63.. 50 

1.62 

41.15 

2.25 

57.15 

0.62 

15.74 

3 

79 

2.25 

57.15 

2.00 

50.80 

1..50 

38.10 

2.00 

.50.80 

0.02 

15.74 

4 

78 

2.50 

63.50 

2.. 50 

63.50 

1.50 

38.10 

2.37 

60.20 

0.62 

15.74 

5 

78 

2.12 

53.84 

1.50 

38.10 

1.31 

33.27 

2.12 

53.84 

0.62 

15.74 

6 

75 

2.37 

60.20 

2.00 

.50.80 

1.37 

34.79 

0..50 

12.70 

DOLICHOCEPHALIC — COLORED. 


NO. 

INDEX 

WIDTH    O  U  T- 
SIDE  1st  MO- 
LAR. 

WIDTH    OUT- 
SIDE 2d    bi- 
cuspids. 

WIDTH    BE- 
TWEEN  2d 

bicuspids. 

ANTERO-P  O  S- 
TERIOR. 

H  E  I  G  HT    OP 
VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

1 

70 

2.12 

53.84 

1.87 

47.49 

1.18 

29.97 

2.18 

55.37 

0.56 

14.22 

2 

69 

2.50 

63.. 50 

2.12 

53.84 

1..50 

38.10 

2.25 

57.15 

0.62 

15.74 

3 

67 

2.. 50 

63.50 

2.18 

55.37 

1..50 

38.10 

2.25 

57.15 

0.62 

15.74 

4 

67 

2.25 

57.15 

2.00 

50.80 

1.18 

29.97 

2.25 

57.15 

0.62 

15.74 

5 

63 

2.25 

57.15 

2.12 

53.84 

1.50 

38.10 

2.25 

57.15 

0.62 

15.74 

6 

60 

2.50 

63.50 

2.25 

57.15 

1.75 

44.45 

2.37 

60.20 

0.68  1  17.27 

BRACHYCEPHALIC,  AVERAGE — WHITE  AND  COLORED. 


RACE. 

WIDTH    O  U  T- 
SIDE  1st  mo- 
lar. 

WIDTH    OUT- 
SIDE   2d    BI- 
CUSPIDS. 

WIDTH      I N- 

siDE  2d  bi- 
cuspids. 

ANTERO-PO  S- 
TERIOR. 

H  E  I  G  HT    OF 
VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

White 

Colored. . . 

2.22 
2.33 

56.38 
59.18 

1.98 
2.06 

50.29 
52.32 

1.19 
1.53 

30.22 

38.86 

2.16 
2.16 

54.86 

54.86 

0  54 
0.61 

13.71 
15.49 

THE    HEAD,    FACE,    JAWS   AND   TEETH 


347 


MESOCEPHALIC,  AVERAGE — WHITE  AND  COLORED. 


RACE. 

WIDTH    O  U  T- 

SIDE  IST  MO- 
LAR. 

WIDTH    O  U  T- 
9IDE    2d    bi- 
cuspids. 

WIDTH    IN- 
SIDE   2d    BI- 
CUSPIDS. 

ANTERO-POS- 
TERIOR. 

HEIGHT    OF 
VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

White  .... 
Colored  .. . 

3.21 
2.43 

56.13 
61.36 

1.95 
2.12 

48.53 
53.84 

1.16 
1.49 

29.47 

37.55 

2.18 
2.16 

55.37 
54.86 

0.52 
0.60 

13.20 
15.24 

DOLICHOCEPHALIC,  AVERAGE — WHITE  AND  COLORED. 


RACE. 

WIDTH    O  U  T- 
SIDE  1st  mo- 
lar. 

WIDTH    OUT- 
SIDE   2d    BI- 
CUSPIDS. 

WIDTH     IN- 
SIDE   2d    BI- 
CUSPIDS. 

ANTEHO-PO  S- 
TERIOB. 

HEIGHT    OF 

VAULT. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

White  .... 
Colored.. . 

2.19 
3.35 

55.62 
59.69 

1.97 
2.09 

50.03 
53.08 

1.50 
1.43 

38.10 
36.06 

2.18 
2.36 

55.37 
57.40 

0.74 
0.63 

18.79 
15.74 

Upon  examination  of  the  figures  of  the  brachycephalic, 
white,  the  first  six  lateral  indexes  are  84.  Taking  the  width 
of  the  dental  arch  we  find  that  it  varies  from  2.12  to  2.62; 
outside  second  bicuspids,  from  1.75  to  2.37;  width  of  vault 
between  second  bicuspids,  from  1  to  1.37;  antero-posterior, 
from  1.87  to  2.37,  while  the  height  of  the  vault  varies  from 
.44  to  ,62.  In  the  mesocephalic,  white,  the  range  varies  from 
2  to  2.50  in  width  of  dental  arch;  width  outside  of  second 
bicuspids,  from  1.62  to  2.25;  width  inside  second  bicuspids, 
from  1  to  1.86;  antero-posterior,  from  2  to  2.37,  and  height 
of  vault,  from  .31  to  .68.  Dolichocephalic:  The  range  width 
of  dental  arch  is  from  2  to  2.37;  width  outside  second  bicus- 
pids, 1.87  to  2.12;  width  between  second  bicuspids,  from  1.25 
to  1.50;  antero-posterior,  from  2.12  to  2.31;  height  of  vault, 
from.62  to.81. 

The  range  of  figures  in  each  group  is  so  great,  and  differs 
so  much  from  each  other,  that  it  will  be  impossible  to  say 
that  any  two  possess  the  slightest  resemblance  to  each  other. 
By  comparing  one  group  with  another,  it  will  be  seen  that 
there  is  very  little  diflference  as  regards  width  and  length  of 
dental  arch,  and  width  of  vault.  There  is,  however,  quite  a 
difference  in  height  of  vault. 


348  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

By  comparing  the  figures  in  the  table  f)f  the  hiteral  index, 
we  do  not  observe  the  slightest  resemblance  in  width,  height 
or  temperament,  nor  can  we  observe  the  slightest  resemblance 
in  the  contour  of  the  vault  and  head.  It  has  been  claimed  that 
the  shape  of  the  vault  is  influenced  by  the  intellect  of  the  indi- 
vidual; that  is,  the  most  intellectual  people  possess  the 
highest  vaults.  With  a  view  of  ascertaining  the  correctness 
of  this  theory,  I  measured  the  heads  of  six  brachycephalic 
(Plates  29  and  30),  six  mesocephalic  (Plates  31  and  32),  and  six 
dolichocephalic  (Plates  33  and  34),  colored  people — waiters  in 
hotels  and  restaurants.  The  white  people  examined  con- 
sisted of  bankers,  editors,  medical  men,  students,  architects, 
bookkeepers — in  fact,  the  most  intelligent  men  that  I  could 
find. 

By  comparing  the  brachycephalic  heads  we  notice  that 
the  highest  lateral  .index  in  the  white  individuals  is  84,  in 
colored  87.  The  highest  width,  outside  of  first  permanent 
molar,  is  white  2.62,  colored  2.87.  This  seemed  to  me  quite 
remarkable.  The  lowest  white  2,  colored  2.25.  In  width  of 
vault,  between  second  bicuspids,  highest,  white  1.37,  colored 
1.62;  lowest,  white  1,  colored  1.31.  Antero-posterior,  greatest 
length,  white  2.50,  colored  2.25.  Height  of  vault,  highest 
white  68,  lowest  37,  with  an  average  of  54;  colored  highest 
75,  lowest  50,  with  an  average  of  61. 

Mesocephalic — Highest  lateral  index,  white  79,  colored 
80.  Highest  width  outside  first  permanent  molar,  white 
2.50,  colored  2.81;  lowest,  white  2,  colored  2.12.  Width  of 
vault  between  second  bicuspids,  highest,  white  1.86,  colored 
1.62;  lowest,  white  1,  colored  1.31.  Antero-posterior,  highest, 
white  2.37,  colored  2.37;  lowest,  white  2,  colored  2.  Height 
of  vault,  highest,  white  .68,  colored  .62;  low^est,  white  .31, 
colored  .50;  average,  white  .52,  colored  .60. 

Dolichocephalic — Highest  lateral  index,  white  72,  colored 
70.  Greatest  width  outside  first  molar,  white  2.37,  colored 
2.50;  lowest,  white  2,  colored  2.12.  Width  of  vault  between 
second  bicuspids,  highest,  white  1.50,  colored  1.75;  lowest, 
white  1.25,  colored  1.18. 

Antero-posterior — Greatest  length,    white  2.31,    colored 


THE     HEAD,    FACE,    JAWS    AND    TEETH  349 

2.37;  smallest,  white  2.12,  colored  2.18.  Height  of  vault, 
highest,  white  .81,  colored  .68;  lowest,  white  .62,  colored 
.56;  average,  white  .74,  colored  .62. 

In  reviewing  the  figures  we  notice  that  the  colored  people 
possess  the  roundest  heads,  while  the  width  of  jaw  is  larger 
in  white,  but  in  the  other  divisions  the  jaws  are  more  uni- 
form in  width. 

A  point  which  must  not  be  lost  sight  of,  and  one  that  I 
have  frequently  noticed  in  ancient  skulls,  is  that  in  the 
colored  race  the  jaw  does  not  diminish  in  width  anterior  to 
the  first  permanent  molar  as  it  does  in  the  white  race.  The 
height  of  vault  seems  to  be  much  higher  in  the  colored  race 
than  in  the  white,  with  the  exception  of  the  dolichocephalic 
heads,  where  it  is  higher  in  the  white  race.  The  height  of 
vault,  like  other  measurements,  is  more  uniform  in  the  white 
race.  Comparing  the  figures  of  the  colored  with  white  people, 
it  will  be  seen,  in  the  average,  that  the  width  and  antero- 
posterior measurements  of  the  colored  people  are  the  largest. 

Since  the  highest  vaults  in  the  brachycephalic  and  meso- 
cephalic  heads  are  found  among  colored  people,  and  in  the 
dolichocephalic  among  the  white,  we  must  conclude  that 
intelligence  has  nothing  whatever  to  do  with  the  contour  of 
the  vault,  and  that  there  is  no  more  comparison  between  the 
vault  and  the  contour  of  the  heads  of  colored  people  than 
there  is  in  white  individuals. 

MOUTH-BEEATHING  NOT  THE  CAUSE  OF    CONTRACTED  JAWS   AND 
HIGH  VAULTS. 

One  of  the  theories  which  has  been  advanced  as  a  cause  of 
high  vaults,  and  one  that  is  still  held  to  by  some  dentists  and 
many  medical  men,  is  that  of  mouth-breathing.  Mouth- 
breathing  is  caused  by  sleeping  with  the  mouth  open,  by 
enlarged  tonsils,  by  adenoid  growth,  by  hypertrophy  of  the 
mucous  membrane  of  the  nose  and  turbinated  bones,  and  by 
arrest  of  development  of  the  bones  of  the  jaw  and  nose.  It  is 
claimed  by  these  men  that  when  the  mouth  is  opened,  press- 
ure is  produced  upon  the  sides  of  the  jaws  and  teeth  by  the 
tension  of  the  buccinator  muscle,  causing  a  contraction  of  the 


350  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

sides  of  the  jaw,  a  protrusion  of  the  teeth,  and  an  elevation 
of  the  vault. 

I  will  direct  attention  to  a  few  facts  as  they  have  been 
presented  to  me  during  a  constant  study  of  the  deformities  of 
the  jaws  and  teeth  for  the  past  eighteen  years. 

In  the  first  place,  let  us  consider  the  parts  involved.  The 
superior  maxillary  bones  are  fused  at  the  median  line.  Their 
under  surfaces  have  imposed  upon  them  the  alveolar  pro- 
cesses. The  maxillary  bones  proper  are  made  up  of  dense, 
compact  tissue,  and  are  so  arranged  as  to  best  resist  certain 
forces.  The  outer  surface  of  the  bone  is  fortified  and  sup- 
ported by  the  malar  process,  which  is  situated  midway 
between  the  maxillary  process  and  the  canine  eminence  at 
the  first  permanent  molar.  At  the  canine  eminence  we  have 
the  strong,  thick  plate  of  bone  extending  from  the  bridge  of 
the  nose  to  the  alee,  the  mesial  portion  forming  the  outer  sur- 
face of  the  nasal  cavity.  We  also  observe  that  the  nasal  sep- 
tum is  situated  at  the  center  of  the  nares  and  is  attached  to 
the  maxillary  bone  at  and  along  the  place  of  union  of  the 
two  halves  of  the  maxillary  bone.  A  saw  passed  through 
from  one  canine  fossa  to  the  other  discloses  in  the  section  the 
strong  trilateral  pillars  of  bone  which  go  to  make  up  the  outer 
surfaces  of  the  nasal  cavity.  These  strong  pillars  of  bone 
are  situated  just  at  the  point  of  the  location  of  the  permanent 
cuspids,  and,  together  with  the  nasal  septum,  form  a  strong 
support  to  the  hard  palate. 

The  maxillary  bones  are  for  the  attachment  of  muscles 
and  the  resistance  of  force  in  masticating  food.  The  hard 
palate  does  not  assume  the  normal  shape  until  the  twelfth 
year,  or  after  the  teeth  are  all  in  position.  The  vault  may 
be  high  or  low,  ranging  from  one  inch  vertically  from  the 
alveolar  plane  on  a  tranverse  line  intersecting  the  alveolar 
crests  between  the  second  bicuspids  and  first  molars  (which 
is  the  highest  vault  I  have  seen)  down  to  one  quarter  of  an 
inch  from  the  same  plane  (which  is  the  lowest  vault  I  have 
observed).  In  either  case  the  vault  may  be  normal;  each 
variety  depending  upon  the  shape  of  the  maxillary  bones 
and  teeth  for  its  peculiar  form. 


THE    HEAD,    FACE,    JAWS    AMD   TEETH 


351 


The  alveolar  process,  on  the  other  hand,  is  made  up  of 
soft  cancellated  structure,  and  is  solely  for  the  purpose  of 
protecting  the  germs  of  the  teeth  before  they  have  erupted, 
and  for  supporting  the  teeth  after  they  are  in  place  in  the 
jaw.  From  the  time  the  teeth  make  their  tirst  appearance 
until  they  are  finally  shed,  the  alveolar  process  has  developed 
and  been  absorbed  three  distinct  times.  The  alveolar  pro- 
cess being  therefore  solely  for  the  protection  and  support  of 
the  teeth,  it  is  logical  to  infer  that  the  position  and  shape  of 
the  alveolar  process  depend  upon  the  location  of  the  teeth. 
The   bone   proper,   therefore,  as  we  shall  see  later,  is   not 


Pig.  105. 

influenced  to  any  great  extent  by  the  movement  of  the  teeth. 
The  buccinator  muscle  is  composed  of  striated  muscular 
fibers,  and  is  therefore  under  the  control  of  the  will.  It  is 
penniform  in  shape.  It  has  its  origin  and  insertion  along  the 
body  of  the  jaws,  above  the  alveolar  process  on  the  upper 
and  below  the  alveolar  process  on  the  lower  jaw.  It  extends 
from  the  first  bicuspid  anteriorly  to  the  wisdom-tooth  pos- 
teriorly. The  center  of  the  muscle  in  one  direction  therefore 
would  be  on  a  line  with  the  grinding-surface  of  the  teeth,  and 
in  a  tranverse  direction  at  the  first  permanent  molar.  It 
•serves  to  compress  air  in  the  act  of  blowing,  whence  its  name. 


352 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


Its  chief  function  is  to  convey  and  hold  the  food  under  the 
teeth  during  mastication. 

There  are  many  cases  of  contracted  arches  and  high  vaults 
where  mouth-breathing  does  not  exist;  there  are  also  many 
cases  of  normal  arches  and  vaults  where  it  is  present.  As 
many  are  aware,  mouth-breathing  frequently  commences  very 
early  in  life;  contracted  jaws,  on  the  other  hand,  never  begin 
to  form  until  the  seventh  or  eighth,  and  in  most  cases  the 
tenth  year,  except  in  cases  of  monstrosities,  or  from  trau- 
matic causes.  When  these  conditions  exist,  the}^  are  wholly 
unlike  the  usual  contracted  arches  and  can  be  diagnosticated 


(lljilljfiiiiijjiffl^^ 

Fig.  11M> 


at  once,  and  therefore  they  should  not  enter  into  this  discus- 
sion. Contracted  arches  are  of  two  kinds — V  (Fig.  105)  and 
saddle-shaped  (Fig.  106) — all  the  other  varieties  being  modifi- 
cations and  blendings  of  these  two.  It  is  apparent  that  the 
cause  which  produces  the  one  does  not  produce  the  other.  My 
observation  has  been  that  there  are  two-thirds  more  V  and 
saddle-shaped  arches  among  the  low  vaults  than  among  the 
high  vaults,  taking  .58  of  an  inch  as  the  average;  but  where 
one  of  these  deformities  exists  with  a  high  vault  it  is  always 
more  marked,  for  the  reason  that  in  the  high  vault  the 
alveolar  process  is  long  and  thin,  with  very  little  resistance, 


THE    HEAD,    P^ACE,    JAWS    AND   TEETH  353 

and  the  teeth  are  more  easily  carried  in  one  direction  or  the 
other. 

In  the  V-shaped  arch,  commencing  at  the  first  permanent 
molar,  there  is  a  gradual  narrowing  of  the  dental  arch  and 
alveolar  process  toward  the  median  line,  where  the  incisors 
may  approximate  a  V  point  or  may  stand  in  their  normal 
position  to  each  other.  Invariably  there  is  a  protrusion  of 
the  teeth  and  alveolar  process,  and  not  of  the  jaw.  On  the 
other  hand,  in  the  saddle-shaped  arch  the  bicuspids  are  car- 
ried inward  and  the  deformity  is  invariably  situated  between 
the  first  permanent  molar  and  the  cuspid.  Unlike  the  V- 
shaped  variety,  the  anterior  teeth  and  alveolar  process  never 
protrude  in  this  class  of  deformities.  The  contracted  hard 
palate  is  always  associated  with  the  V-shaped  variety,  and  in 
most  cases  extends  backward  to  the  second  bicuspid.  It  is 
never  seen  with  the  saddle-shaped  variety. 

The  high  vault  is  never  seen  in  the  first  set  of  teeth,  nor 
does  it  develop  until  the  second  set  are  all  in  place,  which  is 
at  the  twelfth  year.  The  vault  commences  to  slope  slightly 
from  the  neck  of  the  incisor  until  it  reaches  an  imaginary 
line  drawn  across  the  roof  of  the  mouth  from  the  right  first 
bicuspid  to  the  left  first  bicuspid,  and  then  it  gradually  or 
abruptly  slopes  upward  until  a  point  is  reached  which  is  cen- 
tral and  vertical  to  a  line  drawn  across  the  jaw  from  crest  to 
crest  between  the  second  bicuspids  and  first  molars.  From 
this  point  posteriorly  to  the  soft  palate  the  dome  is  usually 
nearly  level  and  parallel  with  the  plane  of  the  alveolar  crests 
of  the  bicuspids  and  molars  when  it  gradually  slopes  and 
unites  with  the  soft  palate.  Occasionally  we  see  a  slight 
relative  depression,  and  occasionally  a  corresponding  slight 
elevation,  but  these  are  so  inconsiderable  as  to  escape  notice 
unless  one  were  looking  for  the  peculiarity. 

In  mouth-breathing  the  lower  jaw  usually  drops  only  suf- 
ficiently for  the  passage  of  the  same  volume  of  air  that  would 
pass  through  the  nasal  cavities  when  in  a  normal  condition, 
each  of  the  openings  to  which  is  equal  to  only  about  one-half 
an  inch  in  transverse  area.  Old  people  often  sleep  with  the 
mouth  open  and  frequently  to  the  fullest  extent,   but  these 


354    .  ETIOLOGY  OF  OSSEOUS    DEFORMITIES   OF 

deformities  of  the  jaws  and  teeth  never  occur  after  the  erup- 
tion of  the  teeth,  say  at  the  twelfth  or  fifteenth  year. 

When  one  opens  his  mouth  he  is  conscious  of  a  tension  of 
the  orbicularis  oris,  but  not  of  a  pressure  of  the  buccinator, 
no  matter  how  wide  the  mouth  may  be  opened.  This  muscle 
being  under  the  control  of  the  will,  is  always  passive  except 
in  the  act  of  blowing  or  eating;  therefore  contraction  during 
sleep  is  wholly  out  of  the  question.  As  the  buccinator  muscle 
extends  anteriorly  to  the  iirst  bicuspid  only,  it  cannot  be  pro- 
ductive of  the  V-shaped  variety  of  deformity,  in  which  is  also 
found  the  contracted  vault.  Therefore  the  only  deformity 
that  is  likely  to  be  so  produced  is  the  saddle-shaped  variety, 
which  is,  in  fact,  out  of  the  question  for  reasons  which  I  shall 
explain  later.  The  orbicularis  oris  muscle  cannot  produce 
the  contraction,  because  when  the  mouth  is  open  the  pressure 
exerted  on  the  six  anterior  teeth  is  backward.  Thus  the  teeth 
should  be  carried  in  the  opposite  direction  from  that  which 
must  be  taken  to  produce  this  deformity.  Again,  the  pres- 
sure is  just  as  great  upon  the  incisors  as  upon  the  cuspids, 
thus  holding  them  in  place.  More  force  is  exerted  by  the 
orbicularis  oris  upon  the  six  anterior  teeth  when  the  mouth 
is  open  than  could  be  exerted,  were  it  possible,  by  the  bucci- 
nator muscle,  which  w^ould  tend  to  hold  the  anterior  teeth  in 
place.  It  has  in  years  past  been  demonstrated  by  dentists,  in 
regulating  teeth,  that  it  is  very  rare  for  the  apices  of  the  roots 
of  teeth  to  move  when  pressure  is  brought  to  bear  upon  their 
crowns  for  the  purpose  of  regulating  them.  This  being  the 
case,  teeth  having  long  roots  like  the  cuspids  are  less  liable 
to  move  than  teeth  with  short  roots  like  the  lateral  incisors 
and  bicuspids.  Since  in  the  moving  of  a  tooth  the  greatest 
change  which  takes  place  is  at  the  neck,  it  stands  to  reason 
that  the  greatest  absorption  and  deposition  of  bone  takes 
place  at  that  point.  The  roots  of  the  cuspids  are  larger  and 
longer  than  those  of  any  other  teeth  in  the  jaw;  unlike  other 
teeth,  the  germs  are  situated  considerably  higher  and  farther 
toward  the  outside  of  the  alveolar  process,  so  that  when  they 
come  closely  into  position  they  diverge  from  the  apices  to  the 
crowns,  while  all  the  other  teeth  stand  nearly  or  quite  perpen- 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


365 


dicular,  thus  showing  that  the  roots  of  these  teeth  do  not 
influence  the  hard  palate.  I  have  shown  that  the  first  perma- 
nent molar  and  the  teeth  posterior  to  it  arc  never  involved, 
except  from  local  causes.  I  have  also  shown  that  the  center 
of  the  buccinator  muscle  in  both  directions  is  located  at  this 
tooth.  How,  then,  is  it  possible,  since  all  the  teeth  are 
covered  by  the  muscle  upon  one  side,  that  half  are  carried 
inward  and  the  other  half  remain  normal? 

Again,  if  mouth- breathing  is  the  cause  of  the  contraction, 
both  sides  should  contract  alike,  and  the  deformity  be  uni- 
form upon  both  sides,  which  is  never  the  case.  By  observing 
the  figure  the  want  of  uniformity  of  the  two  sides  is  easily 


fS^^iW   ^ 


T'-T  W'^n.. 


^v;i^|'l'l^1l|'^ 


if 


Pig.  107. 

observed.  Such  muscles  do  not  contract  to  a  degree  sufii- 
cient  to  induce  the  pressure  necessary  to  produce  a  deformity. 
That  they  should,  is  inconsistent  with  our  knowledge  of  the 
influence  exerted  by  muscular  structure  in  other  parts  of  the 
body.  Some  of  the  muscles  of  the  chest  exert  much  more 
pressure  in  respiration  than  it  is  possible  for  the  buccinator 
to  do  during  sleep,  yet  no  one  would  expect  to  find  the  ribs 
modified  by  this  process.  The  pressure  of  the  contractile 
tissue  upon  the  crowns  of  teeth  is  not  sufficient  to  afi'ect  the 
alveolar  process  through  the  roots  of  the  teeth,  but  even  if  it 
could  modify  that  spongy  structure,  its  force  would  stop  there 
and  would  not  extend  to  the  osseous  vault  and  result  in  bend- 


356 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 


ing  it  out  of  shape.  In  most  of  these  cases  the  diameter  of 
the  superior  niaxiHa,  its  alveolar  process  and  teeth,  is  less  than 
that  of  the  inferior  maxilla,  alveolar  process,  and  teeth.  This 
is  always  the  case  in  the  worst  forms  of  irregularities.  In 
such  cases  the  muscles  and  cheek  could  not  press  upon  the 
teeth  and  alveolar  process  of  the  upper  jaw.  The  changes 
which  take  place  in  the  bone  are  not  a  bendmg  in  at  one  place 
and  a  forcing  out  at  a  weaker  point  to  compensate  for  the 
space  lost,  but  are  an  absorption  and  deposition  of  bone  at 
the  point  of  pressure.  And  even  if  such  were  the  case,  the 
strong  pillar  of  bone  situated  at  the  very  point  of  contraction 


Fig.  108. 


of  the  alveolar  process,  together  ^vith  the  nasal  septum,  con- 
stitute a  strong  bulwark  for  resistance  to  the  pressure,  which 
is  suppositiously  acting  at  a  distance  from  the  top  of  the  vault. 
Again,  it  would  be  as  impossible  to  so  produce  pressure  suf- 
ficient to  break  the  dental  arch  as  it  would  be  for  the  weight 
of  a  building  to  break  the  arch  of  a  door  or  window.  The 
tongue  exerts  a  much  greater  force  in  the  act  of  swallowing, 
and  would  prevent  inward  movement  of  the  teeth  if  so  slight 
a  pressure,  as  the  muscles  of  the  cheeks  could  exert,  were  the 
cause  of  the  deformity. 

For  the  sake  of  the  argument,  let  us  suppose  it  were  pos- 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


!57 


sible  for  the  buccinator  muscle  to  produce  this  contraction; 
we  should  then  expect  to  find  the  modification  of  the  osseous 
structures  uniform.  This  would  shut  out  semi-V-shaped  (Fig. 
107)  and  semi-saddle-shaped  arches  (Fig.  108)  entirely,  and  a 
majority  of  other  irregularities  of  the  teeth  in  which  there  is 
bilateral  asymmetry,  for  however  much  one  might  incline  to 
the  prevalent  theory,  no  one  would  dare  to  assert  that  the 
muscle  will  act  on  one  side  of  the  mouth,  while  that  on  the 
opposite  side  remains  passive.  Partial  V-shaped  (Fig.  109) 
and  partial  saddle-shaped  (Fig.  110)  arches  make  the  theory 
still  less  tenable.       In  these  varieties  we  meet  with  sudden 


FiET.  109. 


bends  inward  where  only  one  or  two  teeth  may  be  involved, 
which  aberrations  could  only  be  produced  by  a  centralization 
of  force  on  one  given  point  or  fiber  of  muscle,  a  peculiarity 
of  function  that  has  never  yet  been  ascribed  to  muscles.  The 
muscle  being  penniform  in  shape,  it  would  be  impossible  for 
one  or  two  fibers  of  the  muscle  to  exert  their  influence  upon 
a  bicuspid.  It  would  naturally  lap  over  two  or  more  teeth. 
Lastly,  if  the  buccinator  acts  as  all  muscles  do — uniformly 
throughout  its  extent  of  contraction — it  is  just  as  efficient 
below  a  median  bisecting  line  in  producing  a  narrow,  con- 
tracted arch  as  in  its  upper  portion,  and  we  should,  there- 
fore, expect  to  find  the  lower  maxilla  contracted  whenever 


358 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


the  upper  one  is,  which  is  contrary  to  facts.  A  V-shapod 
arch  can  never  occur  upon  the  lower  jaw,  if  the  teeth  articu- 
late normally,  because  these  teeth  strike  inside  of  the  upper, 
and  are  thus  prevented  from  moving  forward.  A  saddle,  par- 
tial saddle  or  semi-saddle  arch  may  occur  on  the  lower  jaw,  but 
these  deformities  are  not  often  seen.  When  they  do  occur,  the}^ 
are  the  result  of  improper  occlusion  with  the  teeth  of  the 
upper  jaw.  We  always  observe  in  semi-V  and  partial 
V-shaped  arches  that  the  alveolar  process  is  contracted  upon 
the  side  of  the  deformity.  If  one  side  of  the  arch  is  con- 
tracted more  than  the  other,  we  shall  see  that  the  alveolar 
process  is  contracted  in  proportion  to  the  amount  of  deform- 


Fig.  110. 

ity ;  the  vault  on  that  side  is  not  carried  up  beyond  the  other 
side,  which  is  normal.  In  the  saddle,  semi-saddle  and  par- 
tially saddle-shaped  arches  we  find  the  alveolar  process  built 
up  about  the  teeth  in  precise  conformity  to  the  nature  of  the 
shape  of  the  arch.  If  we  take  three  thousand  models  of  the 
upper  jaw  and  arrange  them  in  groups,  according  to  the  forms 
here  represented,  and  then  examine  very  closely  the  arrange- 
ment of  the  teeth  in  each  group,  we  shall  be  unable  to  find 
any  two  alike  in  either  group;  thus  showing  that  an  external 
force  acting  upon  the  jaws  from  the  outside  could  not  possi- 
bly be  a  cause.  If  that  were  possible,  all  the  models  of  one 
variety  would  resemble  some  definite  form. 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


359 


The  following  tables  will  exliibit  the  differences  in  the 
heights  of  vaults,  both  in  normal  and  defective  jaws.  The 
height  is  taken  centrally  and  vertically  from  the  gingival 
plane  on  a  transverse  line  intersecting  the  gingival  crests 
between  the  second  bicuspids  and  first  molars.  For  com- 
parison with  measurements  of  denuded  crania,  deduct  .07  for 
the  thickness  of  the  soft  tissues.  Fig.  11  shows  the  instru- 
ment used,  and  the  manner  of  making  the  measurements. 

NORMAL   JAW. 


Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

.21 

1 

.40 

1.59 

.56 

9316 

.71 

149 

.2.5 

o 

.43 

183 

.59 

218 

.75 

427 

.28 

70 

.46 

69 

.62 

514 

.78 

69 

.31 

171 

.50 

199 

.65 

150 

.81 

75 

.34 

169 

.53 

429 

.68 

568 

.84 

12 

.37 

146 

Total  number  of  cases,  4,614.    Average,  .58  of  an  inch. 


SADDLE-SHAPED   ARCH, 


Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

.21 

.40 

.56 

6 

.71 

5 

.25 

.43 

.59 

5 

.75 

5 

.28 

.46 

3 

.62 

4 

.78 

1 

.31 

.50 

5 

.65 

.81 

1 

.34 

.53 

5 

.68 

3 

.84 

.37 

1 

Total  number  of  cases,  44.    Average,  .60  of  an  inch. 


V-SHAPED    ARCH. 


Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

.21 

.40 

1 

.56 

15 

.71 

1 

.25 

.43 

.59 

4 

.75 

2 

.38 

.46 

3 

.62 

9 

.78 

.31 

2 

.50 

8 

.65 

.81 

1 

.34 

.53 

3 

.68 

5 

.84 

.37 

4 

Total  number  of  cases,  58,    Average,  .55  of  an  inch. 


360 


ETIOLOGY   OF  OSSEOUS  DEFORMITIES  OF 


SEMI-V    AND    SEMI-SADDLE-SHAPED   ARCH. 


Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

Height 

No.  of 

of  Vault. 

Cases. 

of  Vault. 

Cases. 

of  Vault 

Cases. 

of  Vault. 

Cases. 

.ai 

.40 

..59 

1 

.75 

.25 

1 

.43 

1 

.62 

4 

.78 

1 

.28 

.4() 

.65 

0 

.81 

.31 

.50 

3 

.(•)8 

.84 

. . 

.34 

.53 

3 

.71 

o 

.37 

1 

.5() 

5 

Total  number  of  cases,  24.     Average,  .56  of  an  inch. 

In  order  to  strengthen  further  the  views  herein  suggested, 
I  have  taken  impressions  of  the  mouths  of  a  large  number  of 
mouth-breathers,  and  have  secured  models  of  the  same. 

The  following  illustrations  are  from  models  of  the  mouths 
of  patients  over  twelve  years  of  age.  They  number  from 
1  to  24,  in  the  order  in  which  the  impressions  were  taken.  A 
sufficient  number  of  cases  are  here  illustrated  to  show  the 
general  outline  of  the  jaws  and  teeth  of  the  average  mouth- 
breather. 

In  glancing  over  these  illustrations  (which  are  of  natural 
size)  it  will  be  noticed  that  very  few  have  contracted  arches; 
as  a  rule,  the  vaults  are  less  than  the  average  in  height.  It 
will  also  be  observed  that  no  two  cases  are  exactly  alike, 
which  would  be  the  case  if  the  contracted  jaws  were  caused 
by  lateral  pressure  of  the  cheeks. 

I  wish  here  to  acknowledge  my  grateful  obligations  to 
Drs.  Hawley  Brown  and  Pyncheon,  specialists  in  diseases  of 
the  nose  and  throat,  for  their  kindness  in  sending  me  their 
private  patients. 

Case  I,  Fig.  111. — Hector  M.,  aged  thirteen  years;  nation- 
ality, French;  born  in  Chicago.  Height  of  vault,  .53  of  an 
inch.  Has  always  breathed  through  his  mouth.  Adenoid 
growth  in  post-nasal  spaces.     Collapsed  condition  of  alse  nasi. 

Upon  examining  this  cut  we  observe  that  the  teeth  are 
late  in  erupting,  as  the  patient  is  thirteen  years  of  age.  The 
bicuspids  are  all  through  upon  the  right  side  and  the  cuspid 
is  just  coming  into  place,  while  upon  the  left  side  the  second 
temporary  molar  is  yet  in  position,  the  first  molar  having 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


361 


just  been  removed,  and  the  first  bicuspid  coming  in  its  place. 
The  cuspid  is  not  so  far  developed  as  its  fellow  of  the  opposite 
side.  The  second  permanent  molars  should  also  be  in  place, 
but  they  are  tardy  in  their  development.  While  the  general 
contour  of  the  jaw  is  normal  posterior  to  the  cuspids,  there  is 
a  tendency  of  the  incisors  to  contraction,  with  a  protrusion  of 
the  mesial  surface  of  the  centrals.  It  will  be  readily  noticed 
that  the  cuspids  are  erupting  anterior  to  their  normal  posi- 
tion, thus  crowding  the  incisors  together. 

Case  II,  Fig.  112. — Paul  F.,  aged  nineteen  years;  nation- 
ality,   American.     Height  of  vault,   .75  of  an  inch.     Com- 


Fig.  111. 

menced  to  breathe  throuo;h  the  mouth  at  the  aofe  of  nine 
years,  at  which  time  his  nose  was  broken.  Arrest  of  devel- 
opment of  the  bones  of  the  nose.  Adenoid  growth.  Hear- 
ing and  eyesight  are  poor. 

The  jaw  of  this  case  is  well  developed,  with  a  normal 
palate,  but  higher  than  the  average,  being  three-fourths  of  an 
inch  in  height.  All  the  teeth  have  erupted.  The  anterior 
teeth  have  a  tendency  to  contraction,  due  to  the  fact  that  all 
the  teeth  tend  to  push  forward;  the  central  incisors  do  not 
protrude,  as  in  Case  I,  because  the  lateral  incisors  overlap 
them.  The  right  side  of  the  arch  tends  to  assume  the  saddle- 
shaped  deformity,  due  to  the  position  of  the  bicuspids,  caused 


362  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

by  too  lono"  retention  of  the  temporary  teeth.  It  will  be 
observed  that  the  two  sides  are  markedly  asymmetrical.  This 
cut  nicely  illustrates  the  point  previously  mentioned:  that  if 
contraction  of  the  jaw  were  due  to  contraction  of  muscles  in 
mouth-breathing,  both  sides  would  be  alike. 

Case  III,  Fig.  113. — Miss  Florence  T.,  aged  thirteen  years; 
nationality,  American.  Height  of  vault,  .46  of  an  inch.  Had 
scarlet  fever  at  five  years  of  age.  Commenced  to  breathe 
through  mouth  at  the  age  of  eight.  Arrest  of  development 
of  the  bones  of  the  face  and  nose. 


Fig     112. 

This  is  a  well-marked  illustration  of  defective  develop- 
ment of  the  superior  maxilla,  and  also  of  arrest  of  develop- 
ment of  the  bones  of  the  face  and  nose.  As  in  Case  I,  the 
second  molars  have  not  yet  made  their  appearance.  The 
central  incisors  overlap,  but  do  not  protrude.  The  right  side 
of  the  arch  tends  to  assume  the  saddle-shape  deformity,  due 
to  the  position  of  the  bicuspids.  The  cuspid  has  not  fully 
erupted  on  this  side,  and  is  still  more  tardy  in  its  appearance 
on  the  left.  As  is  true  of  Case  II,  the  two  sides  are  asym- 
metrical, and  the  height  of  the  vault  is  quite  a  little  less  than 
the  average.  When  the  second  and  third  molars  appear,  an 
unusual  protrusion   of   the  anterior  teeth  must   necessarily 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


363 


result  in  order  to  give  safficient  room  for  the  molars.  If  this 
is  allowed  to  progress  without  mechanical  interference,  a 
marked  V-shaped  deformity  will  result. 

Case  IY,  Fig.   114. — Dr.  H.  S.,  aged  twenty -one  years; 
nationality,  American.     Height  of  vault,  .68  of  an  inch.     He 


Fig.  113. 


Fig.  114. 

has  been  a  mouth-breather  all  his  life.  Has  deflection  of 
the  septum  nasi,  and,  at  the  age  of  fourteen,  was  operated 
upon  without  any  benefit.  The  bones  of  the  nose  are  well 
developed,  but  those  of  the  face  are  slightly  arrested. 

While  the  jaw  is  not  quite  as  large  as  the  normal  jaw,  the 
teeth  are  very  regular,  finely  developed,  and  without  a  cavity. 


364  ETIOLOGY  OF  OSSEOUS  DEFORMITIES    OF 

It  would  be  rare  to  find  a  more  nearly  i)erfect  arch.  The 
articulation  with  the  inferior  maxilla  is  at  all  points  exact, 
and  we  have  here  a  marked  illustration  of  an  orthognathous 
jaw. 

Case  V,  Fig.  11.5.— Mr.  William  M.,  aged  fifty-two  years; 
nationality,  American.  Height  of  vault,  .43  of  an  inch. 
Always  breathed  through  the  mouth.  Bones  of  the  nose  and 
face  well  developed.  Last  year  had  hypertrophied  bone 
removed  from  the  nose.  Eyesight  and  hearing  are  good. 
The  jaw  is  well  developed,  and  shows  no  deformity. 

Case  VI,  Fig.  116. — Miss  H.  C,  aged  seventeen  years; 


tlK.  11 


nationalit}'-,  American.  Height  of  vault,  .65  of  an  inch.  Has 
not  always  breathed  through  the  mouth.  Has  adenoid  growths. 
Has  had  measles  and  chicken-pox. 

This  jaw  is  considerably  contracted  throughout,  but  it  is 
more  noticeable  through  its  lateral  diameter.  The  alveolar 
process  is  hypertrophied  on  either  side,  the  hypertrophy  being 
more  marked  on  the  right  side. 

Case  VII,  Fig.  117. — Kate  K.,  aged  seventeen  years; 
nationality,  American.  Height  of  vault,  .65  of  an  inch.  Has 
always  breathed  through  the  mouth.  Has  post-nasal  catarrh. 
Has  had  measles  and  whooping-cough.  This  jaw  was  arrested 
in  its  development,  and  the  first  bicuspids  have  been  extracted 
to  make  room  for  the  other  teeth. 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


865 


The  lateral  incisors  overlap  the  centrals,  due  to  a  lack  of 
room  before  the  extraction  of  the  bicuspids.  The  two  sides 
are  asymmetrical,  the  left  side  diverging  to  allow  the  eruption 
of  the  second  molar. 

Case  VIII,  Fig.  118. — Mr.  H.,  aged  eighteen  years;  nation- 
ality,   American.     Height   of   vault,    .59  of  an   inch.     Has 


Fig.   117. 

always  breathed  through  the  mouth.  Had  scarlet  fever  at 
the  age  of  eighteen  months.  Keceived  a  blow  upon  the  nose 
which  caused  a  deflection  of  the  septum  nasi  to  the  left.  The 
left  nostril  is  entirely  closed  by  hypertrophy  of  bone  and 
mucous  membrane.  There  is  slight  hypertrophy  of  the 
mucous  membrane  of  the  right  nostril,  also  hypertrophy  of 


366 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


the  mucous  membrane  in  the  post-nasal  space.  Arrest  of 
development  of  the  bones  of  the  nose.  Case  VIII  is  an 
illustration  of  marked  arrest  of  development  of  the  entire  jaw. 
The  anterior  teeth  are  much  crowded,  and  on  the  left  side  the 
leteral  incisor  has  erupted  within  the  arch;  that  of  the  right 
side  partially  within  the  arch.  The  cuspids  have  erupted 
outside  of  the  arch;  on  the  right  side  the  sixth -year  molar  has 
been  extracted,  in  consequence  of  which  the  second  molar 
has  pushed  forward. 

In  this  case  the  small  jaw  is  inherited  from  the  mother 
(whose  jaw  was  unusually  small),  and  is  in  harmony  with  the 
bones  of  the  face.     The  teeth,  which  are  exceedingly  large 


Fig.   118. 

and  have  long  roots,  are  inherited  from  the  father,  and  are 
so  out  of  proportion  to  the  small  jaw  that  the  posterior  teeth 
have  moved  forward  and  filled  the  spaces  intended  for  the 
cuspids. 

Case  IX,  Fig.  119. — Geo.  H.,  medical  student,  aged 
twenty-five  years;  nationality,  American.  Height  of  vault, 
.71  of  an  inch.  Commenced  to  breathe  through  the  mouth 
at  the  age  of  ten.  Marked  arrest  of  development  of  the 
bones  of  the  face  and  nose.  The  nasal  cavities  are  small,  and 
the  nasal  septum  is  deflected  slightly  to  the  right.  Hyper- 
trophy of  cartilage  on  the  left  side;  the  mucous  membrane  is 
slightly  thickened.     The  posterior  nasal  cavities  are  clean. 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


367 


The  patient  has  had  measles,  chicken-pox,  mumps,  and 
two  attacks  of  pneumonia.  Had  severe  rheumatism  at  the 
age  of  twenty-one,  and  at  the  present  time  there  is  tuber- 
culosis of  the  left  ankle. 

An  examination  of  the  jaws  revealed  the  following  facts: 
The  lower  jaw  is  excessively  large;  although  all  of  the  teeth 
of  the  lower  jaw  tip  inward,  yet  the  outer  cusps  of  the  upper 
teeth  just  touch  the  inner  cusps  of  the  lower  teeth.  There  is 
marked  arrest  of  development  of  the  upper  jaw,  and  on  the 
right  side  the  arch  has  a  tendency  to  assume  the  saddle-shaped 
deformity.     On  this  side  the  cuspid  has  erupted  externally 


Pig.  119. 


to  the  arch  and  between  the  central  and  the  lateral  incisors; 
its  mesial  surface  is  directed  inward.  The  lateral  incisor  is 
internal  to  the  other  teeth.  The  lateral  incisor  on  the  left 
side  is  situated  internally  to  the  central  incisor  and  cuspid, 
and  has  caused  a  slight  rotation  of  the  central  incisor.  The 
second  molars  are  small,  and  have  erupted  externally  to  the 
first  molar  on  account  of  lack  of  room  in  the  jaw.  The 
alveolar  process  and  mucous  membrane  are  hypertrophied. 

This  case  clearly  shows  that  at  the  time  of  the  formation 
of  the  irregularities  of  the  teeth  the  alveolar  process  and 
mucous  membrane  began  to  hypertrophy;    coincident  with 


368 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


these  was  arrest  of  development  of  the  bones  of  the  face,  nose 
and  jaw,  and  the  habit  of  mouth-breathing  was  formed. 

Case  X,  Fig.  120.— Mr.  William  S.,  aged  thirty-four 
years;  nationality,  German.  Height  of  vault,  .71  of  an  inch. 
Has  always  breathed  through  the  mouth  until  an  operation 
four  years  ago.     He  had  scarlet  fever  and  measles. 

As  will  be  observed,  by  examining  the  cut,  this  jaw  is  well 
developed.  The  central  incisors  overlap  slightly,  due  to  Rigg's 
disease.  The  left  side  has  a  tendency  to  assume  the  saddle- 
shaped  deformity,  due  to  the  position  of  the  bicuspids,  which 


Fig.  120. 

was  probably  assumed  on  account  of  the  too  long  retention  of 
the  temporary  teeth.  The  crowns  of  the  molars  have  decayed 
and  broken  ofl'.  The  thickening  of  the  mucous  membrane  is 
the  result  of  Rigg's  disease. 

Case  XI,  Fig.  121. — M.  W.,  aged  thirteen  years;  nation- 
ality, American.  Height  of  vault,  .62  of  an  inch.  Has 
breathed  through  the  mouth  for  the  past  six  years.  There  is 
arrest  of  development  of  the  bones  of  the  face  and  nose.  The 
patient  has  considerable  catarrh.  Is  now  under  treatment 
for  irregularities  of  the  teeth.  The  jaw  is  much  contracted, 
especially  in  the  anterior  part.  On  the  right  side  the  lateral 
incisor  is  deformed,  and  is  represented  b3^a  conical  tooth  situ- 


THE    HEAD,    TACE,    JAWS    AND    TEETH 


369 


ated  internally  to  the  other  teeth.  Posterior  to  this  is  the 
temporary  cuspid;  on  account  of  the  retention  of  this  tooth 
the  permanent  cuspid  is  eruptino^  externally  to  the  other 
teeth  and  between  the  temporary  cuspid  and  permanent  cen- 
tral incisor.  On  the  left  side  the  lateral  incisor  is  deformed 
in  a  similar  manner  to  that  on  the  right,  but  its  position  is 
normal.  The  temporary  cuspid  on  the  left  side  remains. 
Owing  to  the  fact  that  there  was  insufficient  room  in  the  jaw 
for  the  second  molars,  the  teeth  anterior  to  these  moved 
forward,  producing  the  V-shaped  projection  of  the  central 
incisors. 


Fig.  121. 


Case  XII,  Fig.  122. — Charles  D.,  aged  fifteen  years; 
nationality,  American.  Height  of  vault,  .53  of  an  inch. 
Deflection  of  septum  nasi,  and  thickening  of  mucous  mem- 
brane.    The  patient  has  always  breathed  through  the  mouth. 

This  case  is  similar  to  Case  VIII,  in  that  the  small  jaw 
is  inherited  from  the  mother,  and  the  large  teeth  from  the 
father.  The  dental  arch  is  contracted  anterior  to  the  cus- 
pids, and  the  anterior  teeth  are  crowded;  posterior  to  the  cus- 
pids the  dental  arch  is  normal.  The  first  bicuspid  on  the 
left  side  has  been  removed  to  afford  more  room  for  the  other 
teeth;  the  corresponding  tooth  on  the  right  side  should  also 
have  been  removed.     The  fact  that  it  was  allowed  to  remain 


370 


ETIOLOGY  OF  OSSEOU8  DEFORMITIES    OF 


caused  a  crowded  condition  on  that  side,  and  the  incisor  has 
passed  beyond  the  median  line  of  the  jaw,  encroaching  upon 
the  other  side.  Owing  to  there  l)eing  insufficient  room  in  the 
jaw  for  the  second  mohirs,  the  teeth  anterior  to  these  have 
pushed  forward,  producing  the  V-sliaped  protrusion  of  the 
central  incisors. 

Case  XIII,  Fig.    123.— Mr.   H.  B.,  aged   twenty  years; 

nationality, .     Height  of    vault,   .71  of  an  inch.     Has 

always  breathed  through  the  mouth.  The  alveolar  process 
is  well  developed,  but  the  maxillary  bones  are  arrested  in 
their  development.     The  left  nostril  is  entirely  closed.    There 


4      }    Hr 


Fig.  122. 

is  hypertrophy  of  the  mucous  membrane  of  the  right  nostril. 
Has  had  scarlet  fever  and  whooping-cough. 

Although  there  is  arrested  development  of  the  maxillary 
bones  in  this  case,  no  deformity  is  produced,  owing  to  the  fact 
that  the  teeth  have  crowded  the  alveolar  process  upon  the  outer 
surface  of  the  bone,  thus  forming  a  large  arch.  The  only 
irregularity  of  the  teeth  is  on  the  right  side,  where  the  lateral 
incisor,  by  erupting  slightly  within  the  arch,  has  pushed  the 
distal  surface  of  the  central  incisor  slightly  outward. 

Case  XIV,  Fig.  124. — Mr.  M.  C,  aged  thirty-nine  years; 
natioualitv,  Canadian.     Height    of   vault,    .71    of   an  inch. 


THE     HEAD,    FACE,    JAWS   AND    TEETH 


371 


Had  always  breathed  through  the  mouth  until  ho  came  to 
Chicago  in  1884,  since  which  time  he  has  gradually  improved, 
and  can  now  breathe  partially  well.  He  has  always  suflfered 
from  catarrh,  and  now,  when  a  cold  is  taken,  the  mucous 


Fig.  126. 


Pig.  124. 

membrane  of  the  nose  becomes  inflamed  and  mouth-breath- 
ing is  the  result. 

This   case  illustrates   a  marked   arrest  of   development 
of  the  jaw;  on   account  of  the   small  size  of  the  jaw,  the 


372 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


teeth  anterior  to  the  molars  pushed  forward  and  became 
crowded  when  tlie  molars  erupted.  Upon  the  left  side  the 
second  bicuspid  has  been  removed,  thus  affording  sufficient 
room  for  the  eruption  of  the  second  molar  on  that  side. 

Case  XV,  Fig.  125. — Miss  C,  aged  eight  years;  nation- 
ality, Canadian.  Height  of  vault,  .43  of  an  inch.  Has 
always  been  a  mouth -breather.  Has  suffered  from  catarrh 
for  the  past  five  years.  Her  general  health  has  improved 
since  her  removal  to  Chicago,  six  months  ago.  This  cut 
shows  a  marked  arrest  of  development  of  the  superior  maxilla. 

This  case  is  illustrated  at  this  age,  eight  years,  as  being  of 


Fig.   125. 


unusual  interest  in  connection  with  the  theories  advanced  in 
this  work.  The  usually  low  elevation  of  the  vault  is  due  to 
lack  of  development;  no  doubt  the  normal  height  will  be 
reached  at  the  proper  age.  I  extracted  the  temporary  molars 
and  cuspids  upon  the  left  side,  and  the  temporary  second 
molar  upon  the  right  side,  just  before  securing  the  model. 
Although  the  permanent  bicuspids  and  cuspids  upon  the  left 
side  are  not  visible,  yet  the  appearance  of  the  alveolar  pro- 
cess leads  me  to  believe  that  their  position  will  be  normal. 
Upon  the  right  side  all  the  teeth  belong  to  the  permanent  set 
excepting  the  cuspid.  The  cause  and  manner  of  the  produc- 
tion of  the  saddle-shaped  arch  upon  this  side  of  the  jaw  is 
nicely  illustrated   in   the    position   assumed  by   the    second 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


373 


bicuspid  and  first  permanent  molar.  Upon  removing  the 
temporary  molar,  the  crown  of  the  bicuspid  was  observed  to 
be  situated  exactly  in  the  position  represented  in  the  illustra- 
tion. The  first  permanent  molar,  having  moved  forward, 
has  crowded  the  cuspid  into  the  roof  of  the  mouth.  The  V- 
shaped  appearance  of  the  incisors  is  due  to  lack  of  room  in 
the  jaw  for  their  normal  eruption. 

Case  XVI,  Fig.  126. — Miss  J.,  aged  thirteen  years; 
Hebrew;  born  in  America.  Height  of  vault,  .59  of  an  inch. 
Adenoid  growth  in  post-nasal  space.  She  is  unable  to  breathe 
through  the  nose. 

This  is  a  case  of  unusual  interest;  the  arrest  of  develop- 


Fig.  126. 


ment  is  very  marked,  and  the  maxilla  is  unusually  small. 
The  lateral  incisors  have  never  erupted,  and  the  cuspids  have 
moved  forward  and  taken  their  places.  The  jaw  is  very  nar- 
row across  at  the  bicuspids,  and  much  contracted  anterior  to 
them.     The  jaw  is  of  a  marked  V-shape. 

Case  XVH,  Fig.  127.— M.  L.,  aged  thirteen  years; 
nationality,  American.  Height  of  vault,  .62  of  an  inch.  He 
has  breathed  through  the  mouth  for  the  past  six  years. 
There  is  considerable  arrest  of  development  of  the  bones  of 
the  nose.  The  left  nostril  has  collapsed,  and  the  right  nostril 
partially,  so  that  the  patient  can  breathe  through  that  side 
only,  and  with  difficulty. 

As  will  be  observed,  the  jaw  in  this  case  is  well  developed. 


374 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


The  forward  movement  of  the  incisors  is  due  entirely  to  a 
local  cause,  that  of  irritation,  produced  by  the  lower  teeth 
striking  against  the  roof  of  the  mouth,  which  caused  a  deposit 
of  bone-cells  at  that  point. 


Fig.  127 


Fig.  128. 

Case  XVIII,  Fig.  128.— Geo.  W.,  aged  fourteen  years; 
nationality,  American.  Height  of  vault,  .59  of  an  inch.  Has 
always  breathed  through  the  mouth.  The  septum  nasi  is 
deflected;  there  is  a  hypertrophy  of  the  mucous  membrane, 
and  the  left  nostril  is  closed. 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


375 


In  this  case  the  jaw  is  well  developed,  and  although  the 
teeth  are  large  there  is  no  marked  deformity.  The  central 
incisiors  overlap  slightly;  the  anterior  teeth  protrude  on 
account  of  the  pushing  forward  of  the  posterior  teeth.  A 
side  view  shows  this  forward  inclination  of  all  the  teeth. 

Case  XIX,  Fig.  129.— W.  T.  O.,  aged  twenty-five  years; 
nationality,  American.  Height  of  vault,  .62  of  an  inch.  He 
has  been  a  mouth-breather  for  twelve  years.  The  left  nostril 
is  entirely  closed,  the  result  of  a  blow  received  at  the  age  of 
thirteen. 

In  this  case  the  jaw  is  well  developed.     The  slight  saddle- 


Pig.  129. 

shaped  appearance  of  the  right  side  is  due  to  the  position  of 
the  second  bicuspid  and  first  molar.  The  second  molar  has 
crowded  the  first  molar  forward  and  inward.  Qn  the  left 
side  the  first  molar  has  been  removed  and  the  second  molar 
has  moved  forward,  partially  filling  the  space. 

Case  XX,  Fig.  130. — M.  H.,  aged  sixteen  years;  nation- 
ality, American.  Height  of  vault,  .59  of  an  inch.  Has 
always  been  a  mouth- breather.  There  is  present  a  complete 
collapse  of  the  nostrils. 

This  case  represents  a  small  jaw  anterior  to  the  cuspids. 
There  is  a  slight  protrusion  of  the  anterior  teeth  and  alveolar 


376 


ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 


process.  On  the  left  side  the  hiteral  incisor  has  erupted 
slightly  inward  relatively  to  the  central  incisor  and  cuspid. 
The  two  sides  are  markedh'  as^^mmetrical;  the  left  side  is 
quite  undeveloped. 


Fig.  130. 


Fig.   131. 


Case^XXI,  Fig.   131.— Miss  H.   T.,  aged  ;  nation- 
ality,   .     Height  of  vault,   .62  of  an  inch.     Has  always 

been  a  mouth-breather  because  of  the  thickening  of  the  muc- 
ous membrane  of  the  nose. 


THE     HEAD,    FACE,    JAWS    AND   TEETH 


377 


In  this  case  the  development  of  the  maxilla  has  been 
arrested.  There  is  considerable  protrusion  of  the  anterior 
teeth  and  alveolar  process,  due  to  lack  of  room;  associated 
with  this  is  Riga's  disease.  The  jaw  is  narrow  and  compressed 
in  the  region  of  the  bicuspids.  On  the  right  side  the  first 
bicuspid  has  been  removed  to  aJfford  room  for  the  other  teeth. 
The  left  lateral  incisor  is  small  and  the  left  bicuspids  are  sit- 
uated within  the  arch,  erupting  in  this  position  because  of 
the  retention  of  the  temporary  teeth.  This  side  approxi- 
mates the  saddle-shaped  deformity. 

Case  XXII,  Fig.  132. — J.  G.,  aged  sixteen  years;  nation- 


Pig.  132. 


ality,  American.  Height  of  vault,  .50  of  an  inch.  He  has 
been  a  mouth-breather  for  ten  years.  The  anterior  part  of 
the  jaw  is  contracted,  approximating  the  V-shaped  deformity. 
There  is  no  irregularity  of  the  teeth. 

Case  XXIII,  Fig.  133.— Mr.  G.  C.  A.,  aged  twenty-six 
years;  nationality,  American.  Height  of  vault,  .75  of  an 
inch.     Has  always  breathed  through  the  mouth. 

This  case  illustrates  the  lack  of  harmony  between  the  size 
of  the  jaw  and  the  teeth,  in  consequence  of  which  the  anterior 
teeth  have  erupted  irregularly.  The  central  incisors  overlap 
slightly;  the  approximal  surfaces  of  the  lateral  incisors  are 


378 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 


internal  to  the  palatine  surfaces  of  the  centrals.     Posterior  to 
the  cuspids  the  dental  arch  is  normal. 

Case  XXIV,  Fig.  134.— Miss  E.  B.,  aged  twelve  years; 
nationality,  American.    Height  of  vault,  .53  of  an  inch.    Has 


Fiff.  188. 


Fig.  134. 

always  breathed  through  the  mouth.  Septum  nasi  is  deflected, 
and  the  left  nostril  is  closed.  The  anterior  part  of  the  jaw  is 
contracted,  and  in  consequence  of  this  contraction  the  cen- 
tral incisors  protrude.     The  lateral  incisors  are  slightly  inter- 


THE    HEAD,    FACE,    JAWS   AND   TEETH  379 

nal  to  the  centrals,  lack  of  room  in  the  jaw  preventing  them 
from  assuming  their  normal  position.  It  will  be  noticed  that 
the  cuspids  are  erupting.  On  the  left  side  the  second  tem- 
porary molar  is  seen. 

With  this  presentation  of  a  very  considerable  number  of 
recorded  observations,  accompanied  by  many  representative 
illustrations,  the  writer  respectfully  submits  that  his  conclu- 
sions must  be  deemed  to  be  fairly  founded  on  facts,  a  refu- 
tation of  which  will  require  the  citation  of  a  like  series  of 
actual  observations  on  the  part  of  any  objector  to  the  views 
herein  set  forth. 

DEVELOPMENT   OF    THE    VAULT. 

With  a  view  of  studying  the  true  conditions  of  the  vault, 
I  have  conducted  a  series  of  examinations  with  the  following 
results : 

I  procured  thirty-six  impressions  of  the  mouths  of  chil- 
dren, ranging  from  six  to  twelve  years  (see  Plates  1  to  6),  for 
the  purpose  of  showing  the  development.  These  impressions 
were  taken  in  modeling  compound  as  the  children  came  to 
me;  therefore  were  not  selected  as  regards  conditions  of  the 
mouth.  Two  sets  of  models  were  prepared,  one  for  the 
lithographer,  and  the  other  for  my  own  use.  A  sufficient 
amount  of  compound  was  used  so  that  the  surplus  would 
extend  backward  and  downward  in  order  that  the  contour  of 
the  soft  palate  could  also  be  secured.  This  was  accomplished 
by  the  patients  placing  the  tongue  against  the  compound  and 
breathing  through  the  nose.  Measurements  were  first  taken 
of  the  models,  and  then  they  were  sawed  at  the  median  line. 
One  half  was  placed  upon  paper  and  an  outline  taken,  then 
the  halves  were  glued  together  and  the  saw  passed  through 
the  model  transversely,  just  anterior  to  the  first  permanent 
molar,  then  the  anterior  part  was  outlined,  thus,  in  this 
manner,  the  drawings  were  taken  accurately.  I  am  well 
aware  that  lithograph  plates  do  not  give  as  accurate  an  illus- 
tration of  a  model  as  we  would  like  to  have,  but  they  are 
sufficiently  accurate  for  the  purpose  for  which  they  were 
intended,  viz:  to  show  the  relation  of  the  teeth  to  the  jaw  at 


380  ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 

the  period  indicated  on  each  plate.  These,  together  with  the 
antcro-posterior  (Plates  7,  0,  11,  13,  15,  17),  and  lateral 
drawings  (Plates  8,  10,  12,  14,  16,  18),  give  a  very  good  idea 
of  the  progress  of  development  from  the  development  of  the 
tirst  permanent  molar  through  the  period  of  shedding  the 
temporary  teeth  and  their  places  filled  with  the  second  set. 

I  commenced  my  series  of  illustrations  at  the  sixth  year 
because  it  is  a  well-known  fact  that  deformities  of  the  jaws 
are  rarely,  if  ever,  observed  before  that  period.  I  have 
demonstrated  several  times  in  diflerent  ways  that  the  changes 
which  do  take  place  in  the  jaws  and  vault  are  observed 
between  the  ages  of  six  and  twelve  years,  depending  upon  the 
time  of  the  eruption  of  the  permanent  teeth  anterior  to  the 
first  permanent  molars.  I  secured  only  three  models  at  six 
years  and  three  at  seven  years,  because  the  changes  in  the 
vault  are  so  slight  that  it  would  be  useless  to  occupy  the 
space. 

There  are,  however,  certain  conditions  in  the  contour  of 
the  vault  which  must  not  be  lost  sight  of,  and  which  can  be 
studied  in  these  models  as  easily  as  though  w^e  possessed  a 
large  number.  In  a  general  way  the  vaults  are  quite  low 
and  without  character. 

Starting  at  the  median  line  of  the  cross  sections  (Plates  8, 
10,  12,  14,  16,  18),  the  vault  is  quite  narrow  at  the  upper  por- 
tion, and  the  lines  in  either  direction  diverge  until  the  teeth 
are  reached.  The  teeth  also  diverge  outward.  Very  few  of 
the  models  contain  bicuspid  teeth  until  the  eleventh  year. 

The  alveolar  process  is  quite  thick  in  the  sixth  and  seventh 
year-models,  but  lengthens  and  becomes  thinner  as  age 
.  advances.  The  thickness  is  due  to  the  fact  that  the  antrum 
is  located  between  the  inner  and  outer  plate  of  bone,  and  the 
alveolar  process  not  only  contains  the  roots  of  the  temporary 
teeth,  but  also  the  crowns  of  the  permanent  teeth  as  well. 

The  height  of  the  vault  is  very  low,  and  while  there  is  not 
always  a  gradual  advance  from  year  to  year,  yet,  taken  as  a 
w-hole,  from  the  sixth  to  the  twelfth  year  there  is  quite  a 
little  advance  in  its  height.  The  normal  height  of  vault  is 
not  reached  until  all  the  permanent  teeth  are  in  place,  which 


THE     HEAD,    FACE,    JAW8    AND   TEETH  381 

would  be  after  the  twelfth  year.  With  but  few  exceptions, 
if  a  line  should  be  dropped  from  the  center  of  the  arch,  the 
two  lateral  halves  would  be  nearly  alike.  A  slight  ridge  at 
the  top  of  the  vault  is  noticed  extending  along  the  median 
line  in  Figs.  2,  5,  0,  8,  9,  12,  16,  24,  25,  30,  33,  34  and  36.  I 
have  seen  a  much  more  prominent  ridge  in  the  mouths  of 
children  at  the  age  of  two  years,  as  will  be  seen  in  Plate  A. 
Upon  either  side  of  the  ridge  there  is  an  apparent  groove, 
sometimes  slight,  and  again  quite  marked,  extending  fre- 
quently only  a  short  distance,  then  again  quite  an  extent,  and 
sometimes  the  full  length  of  the  suture.  It  is  not  always  in 
the  same  location,  sometimes  in  the  alveolar  process  behind 
the  incisors,  again  at  the  center  and  often  at  the  posterior 
part  of  the  vault;  however,  it  is  more  frequently  observed  in 
the  anterior  part  of  the  vault  than  in  the  posterior,  and  some- 
times more  marked  upon  one  side  than  upon  the  other,  and 
again  only  upon  one  side.  In  Figs.  3,  6,  12  and  19,  Plates  1, 
2,  4,  the  first  permanent  molars  have  been  extracted. 

In  the  models  of  the  eleventh  and  twelfth  years,  the  second 
bicuspids  are  coming  down  into  place,  although  many  of  the 
temporary  teeth  are  still  in  the  jaw.  Unlike  the  temporary 
molars,  these  teeth  come  down  vertically,  and  although  they 
have  not  fully  erupted,  yet  we  can  see  quite  a  change  taking 
place  in  the  length  and  width  of  the  alveolar  process  and  more 
character  in  both  the  antero-posterior  and  lateral  curves. 

In  the  antero-posterior  section  (Plates  7,  9,  11,  13,  15,  17) 
the  following  changes  are  noticed:  In  Fig.  1  the  temporary 
incisors  are  decayed  down  to  the  gums;  in  Figs.  5,  6,  7,  Sand 
11  the  permanent  central  incisors  are  just  making  their 
appearance,  while  in  others  they  are  about  half  way  through 
or  are  fully  developed. 

Just  back  of  the  incisors  a  thickening  of  the  alveolar 
process  is  noticed;  in  some  it  is  quite  thick,  and  in  others 
thin.  This  I  believe  to  be  due  to  the  relation  of  the  tem- 
porary incisors  to  the  permanent  ones.  If  the  temporary 
tooth  remains  in  the  jaw  until  the  permanent  one  comes 
nearly  through,  the  alveolar  process  will  be  much  thicker 
than  it  ^vould  be  if  the  temporary  tooth  was  removed  earlier. 


3S2  ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 

It  is  also  the  foundation  upon  whicli  the  long,  thin  alveolar 
process  builds  when  the  permanent  teeth  are  in  place.  By 
following  the  line  backward,  we  find  very  little  character  to 
the  curves,  but  as  the  child  grows  older  the  evolution  of 
development  becomes  mere  pronounced.  The  deviation  in 
the  curves  result  in  a  variation  of  ossification  of  the  suture. 
Sometimes  the  ossification  is  uniform  throughout,  in  which 
case  the  line  will  be  uniform  and  graceful,  as  observed  in 
Figs.  1,  2,  3,  7,  9, 10,  11,  15,  16,  IT  and  21.  If  the  ossifica- 
tion is  irregular,  then  the  lines  will  become  wavy  and  irregu- 
lar, as  in  Figs.  4,  5,  6,  8,  12,  13,  14,  IS,  19  and  20. 

The  soft  palate  is  very  accurately  illustrated  in  all  of  these 
drawings,  and  therefore  shows  its  relation  to  the  hard  palate. 
It  will  be  seen  that  the  older  the  patient  grows  the  longer  the 
antero -posterior  line  becomes.  This,  of  course,  can  naturally 
be  expected,  because  the  development  of  the  jaw  is  in  a  pos- 
terior direction.  The  shape  and  inclination  of  the  soft  palate 
seem  to  depend  upon  the  distance  between  the  posterior  sur- 
face of  the  hard  palate  and  the  forces. 

In  examining  the  models  in  Plate  1,  at  six  and  seven  years, 
the  six-year  molars  are  in  place,  and  all  the  temporary  ones 
(except  in  Figs.  3  and  6,  where  the  temporary  incisors  have  all 
been  removed) ;  in  Fig.  6  the  left  central  is  coming  into  posi- 
tion. As  far  as  the  contour  of  the  teeth  is  concerned,  it  is  in 
a  normal  condition. 

Plate  2,  at  eight  years,  the  first  permanent  molars  and 
central  incisors  have  erupted  in  all  the  figures  except  in 
Fig.  12,  where  the  first  permanent  molars  have  been  extracted; 
none  of  the  other  permanent  teeth  have  yet  made  their  appear- 
ance. In  this  plate  we  observe  the  change  that  takes  place  in 
the  shape  of  the  vault.  The  V  arch  is  beginning  to  develop 
in  Figs.  Y  and  9,  and  the  semi-saddle  in  Fig.  11;  in  Figs.  8 
and  19  local  irregularities  of  the  teeth  are  observed. 

Plate  3,  at  nine  years,  the  deformities  of  the  jaws  are  still 
more  marked.  In  Fig.  13  a  semi-saddle  is  nicely  outlined;  in 
Figs.  14,  15  and  16  r  V-shaped  arch  is  noticed,  while  in  Figs. 
17  and  18  the  permanent  teeth  are  not  far  enough  advanced 
to  tell  what  position  they  will  occupy. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  383 

Plate  4,  at  ten  years,  the  teeth  are  a  little  further  advanced 
than  at  nine  years.  The  bicuspids  are  just  pushing  their  way 
through  and  the  jaw  seems  to  be  taking  on  character.  Fig.  19 
shows  the  central  incisors  crowding  their,  way  to  the  right 
side,  producing  a  marked  deformity  of  the  jaw.  Fig.  20  also 
shows  the  incisors  crowding  to  the  right  and  the  left  cuspid 
just  coming  through  the  gums,  producing  a  semi  V-shaped 
arch.  Fig.  21  illustrates  all  the  temporary  teeth  shed  and 
the  bicuspids  first  coming  through;  the  permanent  teeth  are 
not  far  enough  advanced  to  decide  just  what  kind  of  a  deform- 
ity will  be  produced;  from  the  lapping  of  the  central  incisors, 
and  the  fact  that  both  bicuspids  are  erupting  before  the 
cuspids,  it  is  safe  to  say  that  a  V-shaped  arch  will  be  pro- 
duced. The  permanent  teeth  in  Figs.  22,  23  and  24  are  not 
far  enough  along  to  judge  what  the  results  will  be. 

Plate  5,  at  eleven  years,  the  deformities  are  still  more 
easily  traced.  Fig.  25  shows  a  local  irregularity — a  crowd- 
ing inwards  of  the  right  central  incisors — due  to  want  of 
room,  produced  by  the  forward  movement  of  all  the  teeth  on 
the  right  side.  The  V  and  saddle  arches  are  nicely  illustrated 
in  Figs.  28,  29  and  30.  Fig.  28  shows  arrest  of  development 
of  the  maxillary  bones,  and  a  marked  V  arch  will  result. 
This  model  illustrates  the  upper  jaw  of  a  boy,  seventeen  years 
of  age;  his  body  became  arrested  in  its  development  at  about 
nine  years  of  age,  caused  by  some  of  the  eruptive  fevers. 

Plate  6,  at  twelve  years,  the  temporary  teeth  are  yet 
noticeable  in  many  of  these  illustrations.  It  is  easy,  how- 
ever, to  outline  the  forms  of  irregularities  that  will  be  pro- 
duced when  all  the  permanent  teeth  are  in  place. 

We  have  now  fixed  the  date  and  the  character  of  the 
deformity  of  the  vault,  that  will  be  produced  when  all  the 
permanent  teeth  are  in  place,  namely,  between  the  sixth  and 
twelfth  year,  or  at  the  time  of  the  development  of  the  per- 
manent teeth,  and  the  deformity  of  the  vault  will  depend 
upon  the  manner  in  which  the  teeth  came  into  the  jaw  and 
will  be  a  V  or  saddle-shaped  arch  with,.jtheir  modifications, 
partial  V  or  saddle,  semi-V  or  saddle. 

The  shape  of  the  vault  is  also  changed  by  local  irregular- 


384  ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 

Deformed  Vaulk. 


Fig.  185. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  385 

ities  of  the  teeth.  In  such  cases  any  of  the  teeth  may  siand 
inside  or  outside  the  dental  arch  and  the  vault  will  conform 
to  the  deformity. 

DEFORMITY   OF   THE    SUTURE. 

We  have  shown  that  the  deformity  of  the  vault  is  not 
observed  until  at  or  about  the  sixth  year,  or  the  time  of  the 
eruption  of  the  permanent  teeth.  The  ossification  of  the 
suture,  uniting  the  maxillary  bones  at  the  median  line,  how- 
ever, takes  place  at  different  intervals — sometimes  as  early  as 
the  eighth  week  of  inter-uterine  life,  and  as  late  as  the  six- 
teenth. I  have  frequently  demonstrated  this  in  my  treatment 
of  the  deformities  of  the  jaw. 

I  have  observed  the  formation  of  the  excessive  develop- 
ment of  the  suture  as  early  as  the  second  year  and  as  late 
as  the  thirty-sixth  year.  This  excessive  development  takes 
different  shapes  and  forms;  thus,  in  228  Peruvian  skulls, 
240  Stone  Grave  skulls  and  twenty-one  Mound  Builders' 
skulls,  sixteen  Peruvians,  thirty-nine  Stone  Grave,  and  one 
Mound  Builder's  (all  of  which  had  large,  well-developed 
jaws,  normal  in  shape)  possessed  a  rope-like  projection 
extending  the  entire  length  of  the  suture.  This  develop- 
ment appeared  unlike  the  excessive  development  as  noticed 
in  modern  skulls.  It  had  the  appearance  of  having  been  first 
made  and  then  glued  upon  the  suture  as  observed  in  Fig.  135, 
No.  1. 

The  deformity  of  the  suture  in  Nos.  2,  3,  4,  5  and  6, 
varies  in  proportion  to  the  width  of  the  arch  (in  the  narrow 
arch  the  suture  is  quite  low,  or  thick,  while  in  the  normal 
arch  they  are  quite  flat;  the  grooves  of  either  side  of  the 
suture  are  not  uniform,  one  side  being  deeper  than  the  other. 
It  "is  claimed  by  scientific  men  that  these  grooves  are  due 
to  ossification  of  the  vomer,  which  would  produce  rigidity  of 
the  suture,  and  the  bone  upon  either  side  is  afterward  carried 
up.     Thus,  Clouston*  says: 

' '  Those  palates,  where  the  deformity  consisted  in  a  ridge 
down  the  center  antero-posteriorly,  seemed  to  show  that  in 

*  Dental  Record,  May,  1891,  p.  200. 


386 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


PLATE  A 


THE    HEAD,    FACE,    JAWS   AND    TEETH  387 

them  the  deformity  took  place  at  a  later  period  than  in  the 
other  deformed  palates.  When  the  nasal  septum  was  getting 
stronger  and  kept  the  center  of  the  palate  down,  while  on 
each  side  of  it  the  palate  was  drawn  up,  making  two  vaults 
side  by  side,  instead  of  one."  Plate  A,  six  models  are  shown, 
ranging  from  two  to  six  years.  Fig.  1,  at  two  years,  shows 
a  ridge  extending  from  a  line  drawn  across  the  vault  at  the 
cuspids,  through  the  entire  length  of  the  jaw.  Fig.  2,  at  two 
years,  shows  a  similar  condition  of  the  ridges,  except  that  it 
begins  in  the  center  of  the  vault  at  a  line  drawn  across  the 
first  temporary  molar.*  Fig.  3,  at  three  years  of  age,  shows 
a  slight  ridge  just  back  of  the  incisors,  extending  only  a 
short  distance,  when  the  center  of  the  vault  is  perfectly  flat, 
and  the  ridge  begins  again  in  the  posterior  part  of  the  vault. 
Fig.  4,  at  four  years,  shows  the  ridge  starting  at  a  line  drawn 
across  the  vault  at  the  first  molar  and  extending  the  entire 
length  of  the  suture.  Fig.  5,  at  five  years,  shows  a  broad 
ridge  extending  the  entire  length  of  the  vault.  Fig.  6,  at 
six  years,  shows  a  very  narrow  ridge,  also  extending  the 
entire  length  of  the  vault. 

As  the  vault  ossifies  as  early  as  the  first  or  second  year, 
and  as  the  ridge  is  also  found  as  early  as  the  second  year,  the 
vomer  not  ossifying  until  later  in  life,  the  theory  will  not 
hold  good.  The  ridge  takes  so  many  different  shapes  that, 
when  a  number  of  models  containing  it  are  examined,  the 
theory  that  the  sides  of  the  arch  are  drawn  or  pushed  up, 
seems  absurd.  Thus,  models  Figs.  7  and  8,  Plate  B,  show 
vaults  similar  to  No.  2,  Fig.  135,  except  the  grooves  are  deep 
and  sharp.  Fig.  7  extends  from  just  back  of  the  incisors  to 
opposite  the  second  molars  where  the  arch  becomes  perfectly 
smooth  throughout  the  balance  of  the  hard  palate;  Fig.  8 
commences  at  same  point  and  stops  opposite  the  first  perma- 
nent molar.  These  models  alone  show  the  fallacy  of  this 
theory  because  nothing  could  force  the  deep  grooves  in  the 

*The  author  has  a  number  of  these  models  showing  the  ridge  at  the  second 
year,  and  he  has  observed  many  more  in  his  practice.  Since  the  two  halves  of 
the  maxillary  bones  are  supposed  to  ossify  at  the  eighth  week  of  foetal  life,  it 
can  be  readily  seen  that  in  those  cases  where  ossification  was  not  complete 
these  ridges  would  form  when  the  child  begins  to  masticate  its  food. 


388 


ETIOLOGY  OF  OSSEOUS   DEFORJIITIES  OF 


PLATE   B 


THE    HEAD,    FACE,    JAWS    AND   TEETH  389 

anterior  alveolar  process,  as  suggested  by  many  authors,  since 
the  vomer  extends  through  and  beyond  the  anterior  surface 
of  the  anterior  alveolar  process  to  form  the  nasal  spine.  If 
such  a  thing  were  possible,  the  posterior  part  of  the  vaults, 
which  would  easily  yield  to  force,  would  be  affected,  which  is 
not  the  case.  The  ridge  extends  to  the  second  molar,  or  as 
far  as  the  grooves.  One  of  the  jaws  is  very  small  and  con- 
tracted with  slight  hypertrophy  extending  all  around  the 
inner  surface,  giving  the  sharp  appearance  to  the  grooves; 
the  other  is  a  little  larger,  has  no  hypertrophy,  hence  the 
groove  upon  either  side  of  the  suture  is  not  so  narrow, 
although  fully  as  deep.  Figs.  9  and  10,  Plate  C,  show  well- 
developed  jaws  with  very  broad  ridges.  In  Fig.  9  the  ridge 
commences  about  opposite  the  first  bicuspid  and  extends  back 
as  far  as  the  second  molar  tooth;  in  Fig.  10  the  ridge  extends 
from  the  alveolar  process  just  back  of  the  incisor,  to  the  sec- 
ond molar;  both  are  about  the  same  width.  The  grooves 
upon  either  side  are  very  shallow  and  about  the  same  depth 
of  ridge.  These  are  similar  to  Nos.  4,  5  and  6,  Fig.  135. 
Fig.  11,  Plate  D,  is  a  very  small  jaw  with  a  marked  ridge 
commencing  in  the  alveolar  process,  back  of  the  incisors,  and 
extending  as  far  as  the  second  molars;  the  grooves  upon 
either  side  are  very  deep  and  sharp.  This  is  due  to  a  small 
jaw  and  hypertrophy  of  the  alveolar  process.  We  occa- 
sionally find  a  groove  in  the  center  of  the  vault  running 
the  entire  length  of  the  suture  in  place  of  the  ridge,  as 
illustrated  in  Fig.  12,  Plate  D;  this  is  due  to  two  causes:  (1) 
Arrest  of  development  of  the  suture,  and,  (2)  hypertrophy  of 
the  palate  bones  and  mucous  membrane  upon  either  side  of 
the  suture.  This  groove  is  sometimes  shallow,  again  deeper, 
sometimes  broad,  and  again  narrower — depending  upon  the 
extent  of  the  hypertrophy. 

The  two  sides  of  the  contracted  arches  are  not  uniform. 
This  is  due  to  the  location  of  the  teeth  in  the  alveolar  process 
which  are  in  more  upon  one  side  than  upon  the  other,  cany- 
ing  the  alveolar  process  with  it.  The  sides  of  the  palate  are 
not  carried  up,  because  there  is  no  force  to  move  them. 
Sometimes  these  deep  grooves  are  situated  entirely  in  the 


390 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


PLATE   C 


THE    HEAD,    FACE,    JAWS    AND   TEETH  391 

anterior  alveolar  process;  sometimes  entirely  on  one  side; 
sometimes  in  the  center  of  the  vault  in  the  antero-posterior 
direction,  and  asjain  in  the  posterior  part  of  the  vault. 

The  location  of  these  grooves,  especially  those  in  the 
alveolar  process,  and  the  fact  that  sometimes  they  extend 
only  .25  to  .50  of  an  inch,  would  preclude  such  a  theory.  If 
the  sides  were  carried  up,  owing  to  the  very  thin  bone,  a  like 
projection  would  extend  into  the  floor  of  the  nose.  1  have 
examined  1,367  skulls  with  this  deformity,  and  I  have  yet  to 
find  the  first  instance.  In  every  case  the  floor  of  the  nose 
and  commencement  of  the  septum  were  smooth  and  evenly 
developed  throughout  its  entire  length.  How,  then,  are 
these  deformities  to  be  accounted  for?  We  have  seen  that 
these  projections  are  developed  as  early  as  the  second  year, 
and  as  late  as  the  thirty-sixth  year.  We  are  safe  in  the 
assurance,  that  they  are  the  result  of  excessive  development 
of  the  suture,  due  to  irritation  set  up  at  the  time  of  ossifica- 
tion, by  mastication — the  lower  jaw  developing  laterally 
faster  than  the  upper,  thus  crowding  the  superior  maxillary 
bones  apart.  I  have  observed  this  action  in  a  large  number 
of  my  patients,  one  of  which  I  will  here  describe. 

A  lady,  thirty-six  years  of  age,  who  has  been  under  my  care 
for  the  past  fifteen  years,  has  a  space  between  the  central 
incisors  of  .50  of  an  inch.  No  space  was  observed  until  she 
arrived  at  the  age  of  twenty  years.  The  teeth  filled  the  arch 
and  all  antagonized.  The  lower  jaw  continued  to  develop, 
and  the  act  of  mastication  carried  the  superior  maxillary  bone 
laterally — widening  the  suture,  the  space  filling  in  and  pro- 
ducing quite  a  ridge,  as  noticed  in  Fig.  135,  Nos.  i,  5  and  6. 
The  depth  of  the  ridge  depends  upon  the  amount  of  irrita- 
tion. The  height  of  the  groove  upon  either  side  to  the  depth 
of  the  ridge.  When  there  are  grooves  upon  either  side  the 
jaw  is  always  contracted — the  alveolar  process  being  nearer 
the  center  of  the  vault.  This,  together  with  the  ridges,  pro- 
duces the  groove.  If  it  were  not  for  the  excessive  develop- 
ment of  the  median  suture  and  contracted  arch  the  vault 
would  take  the  shape  of  the  dotted  lines  and  would  be  nor- 
mal in  its  development. 


392  ETIOLOIJY  OF  OSSEOUS   DEFORMITIES  OF 


PLATE   D 


THE    HEAD,    FACE,    JAWS    AND   TEETH  393 

DEFORMED   VAULTS. 

Deformed  vaults  are  due  (1)  to  an  irregularity  in  the 
arrangement  of  the  dental  arch,  (2)  hypertrophy  of  the  alve- 
olar process  and  maxillary  bones,  and  (3)  to  excessive  devel- 
opment of  the  palatine  suture.  Irregularities  of  the  dental 
arch  are  the  result  of  two  causes:  (1)  Neuroses  of  develop- 
ment, producing  arrest  of  development  of  the  maxillary  bone; 
(2)  local  causes,  or  the  result  of  accident.  Those  produced 
by  an  arrest  of  development  take  typical  forms,  which  I  have 
classified  by  taking  3,000  models  of  irregularities  of  the  teeth 
and  grouping  them  under  the  heads  of  V,  partial  V,  semi-V, 
saddle,  partial  saddle  and  semi-saddle.  The  irregularities  of 
the  teeth  produced  by  local  causes  do  not  take  typical  forms, 
but  are  as  numerous  as  the  number  of  cases. 

Hypertrophy  of  the  alveolar  process  may  affect  the  whole 
dental  arch,  or  it  may  attack  one  particular  locality  in  which 
only  one,  two  or  three  teeth  may  be  involved.  The  shape  of 
the  vault  in  such  cases  depends  entirely  upon  the  extent  of 
the  hypertrophy,  but  does  not  take  the  typical  form.  The  pos- 
ition, occupied  by  the  teeth  in  the  dental  arch,  and  the  man- 
ner of  their  formation  are  studied  under  their  respective 
heads.  Having  then  found  the  true  cause  of  the  deformed 
vault,  let  us  examine  some  of  them  and  see  how  they  com- 
pare with  the  normal  vault.  I  secured  an  entirely  new  set  of 
models  from  dental  practitioners  in  Chicago,  consisting  of 
six  V-shaped  (Plates  35  and  36),  six  semi-V  (Plates  37  and  38), 
six  saddle  (Plates  39  and  40),  and  six  semi-saddle -shaped 
(Plates  41  and  42).  These  were  prepared  in  the  same  manner 
as  the  other  models. 

The  direction  of  the  teeth  in  a  normal  jaw  are  nearly  per- 
pendicular, while  those  in  the  V-shaped  vault  are  at  an  angle 
of  45°.  This,  of  course,  is  owing  to  the  forward  movement 
of  the  incisor  teeth.  Just  back  of  the  incisor  teeth  there  is 
quite  a  prominent  ridge  of  alveolar  process  noticed  in  the 
drawings  of  the  normal  jaw,  which  is  due  to  the  contraction 
of  the  vault  in  the  anterior  portion,  producing  a  thickening 
of  the  alveolar  process.     In  other  respects  the  vault  does  not 


394  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

differ  from  the  normal  palates.  The  same  general  rule  holds 
good  in  the  semi-V  vault,  except  the  teeth  do  not  stand  at 
such  an  angle.  This  is  accounted  for  by  the  fact  that  fre- 
quently only  one  incisor  protrudes,  therefore  only  one  incisor 
extends;  while  the  other  is  in  a  perpendicular  position.  The 
position  of  the  normal  tooth  may  have  been  on  the  side  of  the 
model  reproduced  in  this  drawing.  In  the  drawings,  show- 
ing a  cross  section  of  the  vault,  it  will  be  noticed  in  a  general 
way  that  the  vaults  are  much  narrower  than  in  the  normal; 
it  will  also  be  noticed  that  the  two  sides  of  the  vault  are  not 
in  harmony.  These  drawings  are  all  very  accurately  made, 
so  that  by  placing  a  rule  at  the  center  of  the  upper  and  lower 
arches  and  drawing  a  line  from  one  to  the  other,  the  two 
sides  of  the  vault  can  be  easily  studied.  The  more  contracted 
the  jaw  the  higher  the  vault  seems  to  be,  and  the  sides  seem 
to  be  more  irregular.  In  the  saddle  and  semi-saddle  antero- 
posterior drawings  the  teeth  stand  perpendicularly,  there- 
fore do  not  protrude.  The  ridge,  posterior  to  the  incisors,  is 
not  so  thick  or  prominent.  The  lateral  drawings  do  not  show 
the  pinched  condition  at  the  upper  part  of  the  vault  that  is 
noticed  in  the  V-shaped  vaults.  This  is  due  to  the  fact  that 
the  contracting  is  not  in  the  anterior  part  of  the  mouth,  but 
at  the  bicuspid  region,  while  the  bicuspids  are  carried  in. 
The  top  of  the  vault  is  rarely  ever  affected.  Occasionally 
hypertrophy  of  the  alveolar  process  is  so  extensive  that  the 
teeth  are  carried  laterally  toward  the  median  line,  the  vault 
is  very  much  narrower,  and  in  some  cases  it  is  almost  closed. 
It  will  also  be  observed  that  the  figures  do  not  correspond  with 
each  class  of  deformities. 

DEFORMED    VAULTS    DUE    TO   LOCAL    IRREGULARITIES    OF   THE 

TEETH. 

Such  irregularities  of  the  teeth  can  only  affect  the  margins 
of  the  vaults,  and  not  the  vault  proper,  as  only  a  few  teeth 
are  involved.  The  remainder  of  the  dental  arch,  being  as  a 
rule  in  a  normal  condition,  the  vault  proper  is  retained  in  its 
natural  shape. 


CHAPTER  XXXI. 

CLEFT  PALATE. 

Cleft  palate  was  much  discussed  by  early  writers.  Early 
in  the  nineteenth  century  Tiedemann*  noticed  that  in  cer- 
tain cases  of  cleft  palate  the  olfactory  nerve  was  absent  or 
abnormal.  He  concluded  therefrom  that  the  deformity  was 
resultant  upon  atrophy  of  the  olfactory  organ  of  nervous 
origin.  This  theory,  however,  failed  to  meet  much  accept- 
ance. M.  J.  Weber,  after  a  careful  analysis  of  all  accessible 
cases,  failed  to  find  one  in  which  the  olfactory  nerve  was 
absent.  In  all  probability  the  coincidence  of  cleft  palate  and 
olfactory  nerve  atrophy  discovered  by  Tiedemann  resulted 
from  the  same  central  nervous  maldevelopment,  and  they 
bore  no  causal  relation  to  each  other. 

The  etiology  of  cleft  palate  is  necessarily  involved  in 
obscurity,  since  cleft  palates  are  comparatively  rare,  in  pro- 
portion to  other  forms  of  nutritive  degeneracy,  and  since 
they  occur  so  early  in  foetal  life.  Palatal  embryology,  to  a 
certain  extent,  casts  light  on  the  aetiology,  f  At  a  very  early 
period  of  fcetal  life  a  series  of  clefts  appear  on  each  side  of 
the  cephalic  extremity,  separated  by  rods  of  tissue  called 
branchial  arches.  The  clefts  communicate  with  the  alimen- 
tary canal.  These  various  clefts  have  usually  coalesced  about 
the  ninth  and  tenth  week  of  foetal  life,  but  occasionally  this 
coalescence  fails  or  is  incomplete.  This  leads  to  various 
deformities,  the  chief  of  which  are  cleft  palate  and  harelip. 
After  an  analysis  of  these  embryological  factors,  that  able 
teratologist,  Bland  Sutton,:}:  states  that  "  cleft  palate  has  been 
known  to  affect  several  members  of  the  same  family  and  ta 
occur  in  the  offspring  of  the  affected  members."  He  cites 
instances  of  the  transmission  of  this  deformity  from  an  affected 
pug-bitch  to  her  offspring.     He  states  further,    "if  it  were 

*  Zeitschrift  f .  Phys.,  Band  1,  Heft  1, 1844,  p.  71. 
t  Keen's  American  System  of  Surgery,  p.  639. 
X  Evolution  and  Disease,  p.  189. 

395 


396  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

possible  to  practice  selective  breeding  in  man  as  in  dogs, 
a  race  of  men  with  harelips  and  cleft  palates  could  be 
produced.''' 

Engle  refers  cleft  palate  to  excessive  development  of  the 
anterior  portion  of  the  brain  and  skull,  such  as  produces 
hernia  cerebri.,  ventricular  atrophy  or  excessive  anterior  cer- 
ebral lobe  development.  This  mixed  patho-teratological  theory 
is  not  warranted  by  either  embryology  or  clinical  observation. 
The  narrow  and  broad  foreheads  are  alike  affected. 

Lanofdon  Down  has  found  a  constant  relation  between 
brain  deformity,  cleft  palate,  and  deformed  vaults.  Down 
states  that:  "The  cause  of  the  frequent  excessive  vaulting  of 
the  palate  is  not  quite  clear.  It  may  possibly  arise,  as  has 
been  suggested,  from  sphenoid  arrest  of  development  or 
vomer  defects  in  development."  It  has  been  plausibly  shown 
that  the  contracted  high  vault  is  not  due  to  these  conditions, 
and  that  there  can  be  no  relation  between  contracted  vaults 
and  cleft  palates.  The  cleft  occurs  before  the  tenth  week  of 
foetal  life,  while  the  contracted  vault  does  not  appear  until 
after  the  sixth  year.  The  claim  is  made  by  Walther*  and 
Langenbuchf  that  cleft  palate  was  becoming  more  frequent 
during  the  present  century.  This  opinion  was  supported  by 
Oakley  Coles,:}:  on  the  ground  that  palatal  vault  deformities 
were  more  frequent,  and  that  a  relationship  existed  between 
these  and  cleft  palate.  He  further  states  that  "we  shall  be 
led  to  the  inevitable  conclusion  that  the  relation  between  a 
high  state  of  civilization  and  a  high  proportion  of  palatal 
deformities  is  something^  more  than  a  mere  matter  of  coinci- 
dence." 

In  the  study  of  this  subject,  however,  an  assumed  relation- 
ship between  palatal  deformities  and  cleft  palate  may,  for 
reasons  ersewhere  given,  be  at  once  dismissed  from  con- 
sideration. 

Early  literature  on  this  subject  is  admittedly  meagre. 
The  early  teratologists  discussed  the  gross  rather  than  the 

*Graefe  and  Walther's  Zeitschrift,  Band  21,  Heft  2, 1834,  p.  175. 
t  Neue  Bibliothek  f.  die  Chir.,  Band  4,  Heft  3,  p.  492. 
J  Coles:  Deformities  of  the  Mouth. 


THE     HEAD,    FACE,    JAWS    AND   TEETH  397 

minute  details,  and  the  registration  of  cleft  palates  was 
neglected  in  common  with  brain,  renal,  hepatic,  and  cardiac 
teratology. 

Cleft  palate  may  be  divided  into  two  classes — congenital 
and  acquired.  By  congenital  is  meant  existing  at  birth; 
acquired  cleft  palate  is  the  result  of  disease,  inherited  or 
acquired,  but  affecting  the  part  after  birth.  It  is  not  intended 
here  to  discuss  this  subject,  except  to  indicate  that  better 
acquaintance  with  etiology  of  disease,  and  its  effects  upon  the 
hard  palate,  will  show  causes  of  congenital  lesions  and  effects 
of  acquired  disease  upon  the  tissues  to  be  at  least  allied. 

Congenital  cleft  palate  is  divisible  into  two  kinds — 
complete  and  partial;  complete  when  the  fissure  extends  the 
entire  length  from  the  uvula  to  and  including  the  anterior 
alveolar  process,  and  even  the  lips;  partial  when  only  a  small 
part  of  the  structure  is  involved.  Thus  the  cleft  may  extend 
through  the  anterior  alveolar  process,  involving  only  the  inci- 
sive bones,  which  is  very  rare;  when  present,  single  or  double 
harelip  almost  invariably  co-exists.  I  have  observed  in  prac- 
tice six  cases  where  a  small  portion  of  the  anterior  alveolar 
process  and  jaw  was  involved,  with  one  or  two  teeth.  The 
hard  palate  only  may  be  involved  to  the  extent  of  a  small 
fissure,  or  the  whole  palate  may  be  wanting.  The  soft  palate 
only  may  contain  the  cleft  or  simply  the  uvula.  Cases  are 
on  record  in  which  the  non-development  of  the  intermaxillary 
bones  produces  fissures  in  the  lip.  A  priori  cleft  palate  would 
seem  to  be  an  expression  of  hereditary  defect.  This  view  is 
that  taken  by  Bland  Sutton*  from  actual  observation.  Oakley 
Colesf  states  that  ' '  the  antecedent  which  strikes  one  a  priori^ 
as  being  likely  to  play  the  most  important  part  in  the  pro- 
duction of  congenital  deformities,  is  that  of  hereditary  influ- 
ence. But  though  it  will  be  evident  from  the  facts  which  I 
shall  presently  adduce  that  the  indirect  influence  of  heredity 
in  the  production  of  cleft  palate  is  marked  and  undeniable, 
no  sufficient  statistics  have  as  yet  been  brought  forward  to 
show  that  the  actual  presence  of  the  deformity  in  the  parent 

*  Evolution  and  Disease. 
t  Deformities  of  the  Mouth. 


398  ETIOLOGY   OF  OSSEOUS   DEFORMITIES  OF 

has  any  direct  predisposing  influence  on  its  occurrence  in  the 
child.  In  other  words,  though  the  defective  conditions  which 
precede  and  accompany  the  phenomenon  of  cleft  palate  are 
almost  certainly  to  be  referred  to  parental  influence,  it  is 
extremely  doubtful  whether  cleft  palate  is  in  itself  transmis- 
sible. I  am  fully  aware  that  such  distinguished  authorities 
as  Demarquay,  Roux,  Trelat,  Follin  and  Duplay  are  inclined 
to  an  opposite  belief,  and  their  conclusion  is  supported  by  the 
evidence  in  connection  with  the  analogous  deformity  of  hare- 
lip. Still,  unless  accurate  records  of  ancestry  could  be 
obtained  for  three  or  four  degrees  of  removal,  it  would  be 
premature  to  make  any  positive  assertion  on  the  point.  I 
feel,  however,  that  it  may  be  confidently  stated  that  the 
deformity  cannot  be  produced  from  anj^  impression  received 
by  the  mother  during  pregnancy.  In  most  of  the  cases 
which  have  come  immediately  under  my  notice,  where  one  of 
the  parents  had  a  cleft  palate,  all  the  children  born  have  been 
perfectly  developed,  even  though  dread  of  transmitting  the 
deformity  was  always  present  in  the  mind  of  the  mother. 

"In  one  case,  curiously  enough,  there  are  three  members 
of  one  family  with  cleft  palate,  one  seventeen  years  of  age, 
the  other  thirty,  and  the  third  thirty-five;  the  first  and  last 
are  ladies,  the  other  a  gentleman  who  is  married  and  has  a 
family  without  any  trace  of  the  father's  deformity.  In  these 
cases  no  instance  of  cleft  palate  could  be  found  either  among 
the  ancestors  or  the  collateral  branches  of  the  family;  but  it 
will  be  interesting  to  watch  whether  in  the  following  gener- 
ations any  traces  spring  up  again,  for  cases  of  immediate 
transmission  seem  but  rarely  to  have  been  placed  on  record. 

"  In  the  case  of  another  family,  however,  I  have  obtained 
the  following  remarkable  history: 

"G.  H.  C,  born  1853;  perfect.  L.  C,  born  1855;  single 
harelip  and  cleft  palate.  J.  F.  C,  born  1856;  perfect.  F. 
W.  C,  born  1860;  double  harelip  and  cleft  palate.  H.  E.  C, 
born  1863;  perfect.  The  paternal  grandmother  also  had  cleft 
palate." 

My  own  observations,  so  far  as  they  go,  only  justify  me 
in  taking  the  tentative  position  of  Coles. 


THE  v^HEAD,    FACE,    JAWS  » AND   TEETH  399 

Knecht*  found  five  per  cent  of  1,200  criminals  examined 
to  have  cleft  palates,  and  fourteen  per  cent  of  the  prostitutes 
examined  by  Pauline  Tarnowskyf  had  cleft  palates.  Dr. 
Langdon  Down  among  congenital  idiots  found  only  a  half  per 
cent  of  cleft  palates.  Grenser  only  found  nine  cases  in 
14,466  children,  or  one  in  1,607.  I  examined  1,977  feeble- 
minded children  without  finding  a  single  case.  In  207  blind, 
but  one  case  was  observed.  In  1,935  deaf  mutes  two  cases, 
or  about  one  in  1,000.  The  percentage  among  the  defective 
classes  is  not  large,  but  undoubtedly  it  is  much  larger  than 
among  normal  individuals. 

Bland  Sutton's  experiments  with  dogs,  elsewhere  cited, 
indicate  the  presence  of  this  deformity  among  animals,  and 
further,  that  it  is  transmitted.  The  followers  of  Weissmann, 
relying  upon  his  dictum:}:  that  acquired  defects  are  not  trans- 
mitted, will  dispute  the  validity  of  these  experiments.  Weiss- 
mann's  original  position  on  this  subject  has  been  abandoned 
by  him,  for  he  states, §  in  his  latest  work,  that  "the  origin  of 
a  variation  is  equally  independent  of  selection  and  amphimixis, 
and  is  due  to  the  constant  occurrence  of  slight  inequalities  of 
nutrition  in  the  germ  plasm."  The  influence  of  this  factor  is 
shown  by  the  statistics  of  zoological  gardens.  A  keeper  of 
the  Zoological  Gardens  in  Philadelphia  observed  cleft  palates 
in  the  mouths  of  lion  cubs  born  in  the  gardens.  Cleft  pal- 
ates were  also  observed  in  a  number  of  pups  born  in  Buffalo. 

Dr.  Ogle  found  that  ninety-nine  per  cent  of  the  lion  cubs 
born  in  the  London  Zoological  Gardens  had  cleft  palates.  He 
claims  this  is  due  to  the  artificial  diet  as  the  result  of  enforced 
captivity.  Similar  results  observed  in  other  gardens  in  Europe 
are  charged  to  feeding  the  mother  with  meat  without  bone. 
Feeding  with  the  whole  carcass  of  small  animals  greatly 
diminishes  these  deformities. 

It  would  seem  that  if  cleft  palate  could  be  attributed  to 
this  cause,  other  bony  structures   should  also  be  involved. 


*  Cited  by  Lombroso,  Criminal  Man. 
t  Etudes  Anthropometriques. 
X  Essays  on  Heredity. 
§  The  Germ  Plasm. 


400  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

Many  of  the  lions  born  in  captivity  were  rickety.  Cleft  palate 
has  been  observed  among  dogs,  sheep,  goats,  etc.  The  ques- 
tion, therefore,  whether  domesticity  does  not  play  in  them 
the  alleged  part  of  civilization  in  man,  can  be  solved  only  by 
a  knowledge  of  the  frequency  of  the  condition  among  wild 
animals  of  the  same  genus.  It  is  evident  that  in  dealing  with 
the  question  of  a?tiology  the  influence  of  shock  on  the  mother's 
nervous  system  cannot  be  excluded  in  the  cases  charged  to 
feeding. 

It  may  be  here  of  interest  to  note  the  date  of  the  develop- 
ment of  the  parts  chronicled  by  Beaunis  and  Bouchard: 

"  Beginning  of  third  week — first  pharyngeal  arch;  buccal 
depression.  End  of  third  week,  coalescence  of  the  inferior 
maxillary  protuberances;  formation  of  the  three  last  pharyn- 
geal arches.  Fourth  week — olfactory  fossm.  Fifth  week 
— ossification  of  lower  jaw.  Sixth  week — the  pharyngeal 
clefts  disappear;  the  tongue,  the  larynx  and  germs  of  teeth. 
Seventh  week — points  of  ossification  of  intermaxillary  bone; 
palate  and  upper  jaw  (its  first  four  points).  Eighth  week — 
the  two  halves  of  the  bony  palate  unite.  Ninth  week — 
osseous  nuclei  of  vomer  and  malar  bone;  the  union  of  the 
hard  palate  is  completed.  Third  month — points  of  ossifica- 
tion for  the  sphenoid  and  nasal  bones;  squamous  portion  of 
temporal;  orbital  center  of  superior  maxillary  bone;  com- 
mencement of  formation  of  maxillary  sinus;  epiglottis.  Fifth 
month — osseous  points  of  lateral  masses  of  ethmoid;  ossifica- 
tion of  germs  of  teeth;  appearance  of  germs  of  permanent 
teeth." 


CHAPTER  XXXII. 

NEUROSES  OF  DEVELOPMENT  OF  IRREGULARI- 
TIES OF  THE  TEETH. 

THE   V-SHAPED    ARCH. 

Irreo^ularities  of  the  teeth  and  jaws,  resulting  from  exces- 
sive development,  have  been  described.  It  remains  now  to 
show  how  irregularities  result  from  arrested  development. 

Arrest  of  development  is  confined  mostly  to  the  upper 
iaw;  hence  V  and  saddle-shaped,  arches  are  more  numerous 
than  irregularities  of  the  lower  jaw.  Local  conditions,  such 
as  premature  extraction  of  the  temporary  teeth,  causing  the 
first  permanent  molars  to  move  forward,  thus  diminishing  the 
size  of  the  jaw,  are  also  the  cause  of  these  irregularities. 

The  manner  of  these  formations  is  as  varied  as  the  peculi- 
arities themselves. 

It  may  be  well  at  the  outset  to  state  that  the  only  structures 
involved  in  the  formation  of  these  deformities  are  the  jaws 
and  the  alveolar  process  on  the  one  hand,  and  the  teeth  upon 
the  other.  The  alveolar  process  is  soft  and  yielding,  while 
the  teeth  and  jaws  are  composed  of  hard,  unyielding  sub- 
stances. The  process  adapts  itself  to  the  conformation  of 
the  teeth.  We  are  taught  that  the  teeth  of  the  superior  or 
inferior  maxilla  constitute  a  dental  arch,  and  that  the  first 
permanent  molars  perform  the  function  of  keys  to  the  arch. 
After  years  of  thorough  investigation  I  find  that  the  jaws  and 
teeth,  like  the  lateral  halves  of  the  body,  develop  independ- 
ently of  each  other,  both  possessing  their  own  peculiar  char- 
acteristics as  regards  irregularities  of  the  teeth.  In  order  to 
simplify  the  classification  of  irregularities  of  the  teeth  I  shall 
call  the  lateral  halves  of  the  jaws  which  are  separated  by  the 
median  line,  the  right  and  left  inferior  and  the  right  and  left 
superior  dental  arches.  While  these  terms  as  applied  to  the 
lateral  halves  of  the  maxillary  bones  are  not  strictly  correct 
from  an  architectural  point  of  view,  yet  practically  (as  will 

401 


402  ETIOLOGY  OF   OSSEOUS  DEFORMITIES  OF 

be  seen)  they  answer  the  purpose  for  which  they  are  employed. 
The  manner  of  the  formation  of  the  V-shaped  arch  and 
kindred  deformities  may  be  compared  to  the  construction  of 
an  arch  of  stone.  The  changes  which  take  place  in  the  move- 
ment of  the  teeth  are  very  similar  to  those  which  may  occur 
in  a  stone  arch  of  faulty  construction.  Figs.  136, 137  and  138 
represent  one  normal  arch  and  five  varieties  of  irregularities 
of  the  teeth.  Each  lateral  arch  is  viewed  as  containing  stones 
corresponding  in  number  and  size  with  the  teeth  of  a  normal 
upper  denture.  Fig.  136  represents  two  arches;  the  left 
superior  arch  is  perfect.  The  first  stone  is  marked  "  posterior 
base,"  and  corresponds  to  the  first  permanent  molar.  The 
second  stone  is  the  "anterior  base";  it  correponds  to  the 
central  incisor.  The  next  stone  is  located  upon  the  anterior 
base  and  corresponds  to  the  lateral  incisor.  The  succeeding 
stones  are  laid  upon  the  posterior  base,  and  represent  the  first 
and  second  bicuspids.  The  stone  corresponding  to  the  first 
bicuspid  is  usually  in  position  first,  but  sometimes  the  stone 
corresponding  to  the  second  bicuspid  is  placed  first.  To  com- 
plete the  arch  it  is  necessary  to  place  the  "key-stone"  in 
position — the  cuspid  tooth.  If  the  stones  have  proper  pro- 
portions and  the  measurements  are  correct,  the  key-stone  will 
fit  into  place  and  the  arch  will  be  complete.  We  shall  find 
on  examining  the  foundations,  two  more  stones,  which  cor- 
respond with  the  second  and  third  molars;  these  stones,  with 
the  base  and  the  stones  above  the  base,  making  a  strong  abut- 
ment. 

THE    NORMAL   ARCH. 

In  order  that  aberrations  from  the  normal  may  be  better 
understood,  let  us  first  consider  the  question,  what  consti- 
tutes a  normal  arch. 

There  are  three  characteristics  of  the  normal  arch.  Inde- 
pendent of  temperamental  peculiarities,  the  line  extending 
from  one  cuspid  to  another  should  be  an  arc  of  a  circle,  not 
an  angle  or  straight  line;  the  lines  from  the  cuspids  to  the 
third  molar  should  be  straight,  curving  neither  in  nor  out, 
the  sides  not  approximating  parallel  lines.     Absolute  bilateral 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


403 


uniformity  is  not  implied  in  this,  as  the  two  sides  of  the 
human  jaw  are  rarely  if  ever  wholly  alike.  A  uniform  arch 
necessitates  a  uniformity  of  development  between  the  arch  of 
the  maxilla  and  the  arch  of  the  teeth,  and  a  correct  position 
of  the  individual  teeth  in  their  relation  to  each  other.  When 
there  is  inharmony  of  development  between  the  jaw  and  the 
teeth,  as  may  happen  when  one  parent  has  a  small  maxilla 
with  correspondingly  small  teeth,  and  the  other  a  large  one 
with  correspondingly  large  teeth,  if  the  child  inherits  the  jaw 
of  one  and  the  teeth  of  the  other,  irregularities  must  follow. 
Such  difference  in  diameter  between  the  arch  of  the  maxilla 


Fig.  136. 

and  that  of  the  crowns  of  the  teeth  is  a  constitutional  cause 
of  irregularity. 

Whenever  there  is  a  difference  between  these  diameters, 
the  line  formed  by  the  teeth  must  either  fall  outside  or  within 
the  arch  of  the  maxilla,  and  irregularities  of  arrangement 
result. 


FORMATION    OF   THE   V-SHAPED   ARCH. 

In  Fig.  136  the  right  superior  arch  shows  the  diameter  of 
the  stones  to  be  either  too  small  for  the  curve  of  the  arch,  or 
that  the  bases  were  set  too  far  apart  for  the  curve  of  the  arch. 
This  results  in  a  greater  space  for  the  key-stone   than   is 


404 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


required,  and  not  finding  support  it  drops  through  toward 
the  center  line. 

In  Fig.  137  the  right  superior  arch  shows  that  the  poste- 
rior base  and  the  foundation  stones  have  been  brought  for- 
ward to  such  an  extent  that  when  the  other  stones  are  placed 
in  position,  the  space  intended  for  the  key-stone  is  entirely 
closed  and  the  key-stone  remains  outside  the  arch.  The  left 
superior  arch  appears  as  though  the  key-stone  were  too  heavy 
for  the  arch,  and  its  weight  has  carried  the  smaller  stones 
with  it.     The  posterior  base  with  its  foundation  stones,  being 


Fig.  137. 

the  strongest,  resists  the  force;  the  anterior  base  being  weak 
and  Avithout  support,  bulges  out,  and  in  this  way  a  semi-V- 
shaped  arch  is  produced. 

Fig.  138  illustrates  the  V-shaped  arch.  The  right  supe- 
rior arch  shows  that  the  key-stone  has  gradually  carried  the 
arch  inward;  the  posterior  base  is  in  its  proper  position,  the 
anterior  base  has  been  carried  forward,  and  all  the  stones  are 
in  line.  The  key-stone  in  the  left  superior  arch  has  produced 
the  same  result  as  upon  the  opposite  side,  excepting  that  the 
posterior  base  and  the  foundation  stones  were  placed  too  far 
forward,  leaving  insufficient  space  for  the  key-stone.  The 
teeth,  however,  do  not  bear  the  same  relation  to  one  another 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


405 


upon  their  approximal  surfaces  that  the  stones  of  the  arches 
do.  The  stones  of  an  arch  have  broad,  flat  surfaces,  while 
the  teeth  touch  merely  upon  the  points  of  rounded  surfaces. 
The  ten  anterior  teeth  which  are  involved  in  the  construc- 
tion of  the  V-shaped  and  kindred  irregularities,  are  illustrated 
in  Fig.  139,  in  which  the  positions  of  the  roots  and  crowns,  and 
their  mutual  relations,  are  approximately  shown.  As  will  be 
observed,  the  teeth  are  all  wedge-shaped,  the  bases  being 
located  near  the  cutting  and  grinding-edges  and  the  apices  at 
the  ends  of  the  roots.  These  are  nearly  round  and  conical, 
the  points  of  antagonism  being  near  or  quite  at  the  cutting  or 


Fig.  138. 

grinding  edges.  Fig.  140  shows  a  section  of  the  teeth  at 
their  points  of  contact.  These  points  must  be  kept  in  mind, 
as  they  constitute  the  fulcra  of  the  levers,  which,  when  force 
is  applied  to  the  teeth,  cause  them  to  rotate  and  move  out  of 
position,  thus  producing  a  greater  variety  of  deformities  than 
it  is  possible  to  demonstrate  upon  the  stone  arch. 

As  has  been  previously  mentioned,  these  irregularities  are 
not  observed  until  after  the  eruption  of  the  second  set  of 
teeth.  We  shall  therefore  first  consider  the  first  permanent 
molars.  These  teeth  are  the  largest,  strongest,  and  possess 
the  largest  roots  of  any  of  the  teeth.  They  are  located  pos- 
teriorly to  the  temporary  set.      Owing  to  their  position  and 


406 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


to  the  fact  that  they  have  long,  large  roots,  their  apices  are 
directed  backward,  and,  in  a  majority  of  cases,  the  distance 
from  the  apex  of  one  root  to  that  of  another  is  greater  than 
at  the  neck,  which  fact  indicates  that  they  are  firmly  fixed  in 
their  alveoli.  The  alveolar  process  is  wide  at  those  points; 
these  teeth  therefore  would  naturally  be  designated  as  the 
posterior  basis  of  the  lateral  arches. 

The  next  teeth  which  make  their  appearance  are  the  cen- 
tral incisors.     These  are  situated  in   the  extreme   anterior 


Fig.  140.  ■ 

alveolar  process  on  either  side  of  the  median  line,  and  the 
process  is  quite  thin  at  these  points.  These  teeth  will  be 
called  the  anterior  bases  of  the  lateral  arches.  The  next  to 
make  their  appearance  are  the  lateral  incisors,  which  take 
positions  at  the  distal  surfaces  of  the  central  incisors.  The 
roots  of  these  teeth  are  not  so  large  nor  so  long  as  the  roots 
of  the  centrals;  therefore  they  are  not  as  firmly  fixed  in  the 
alveoli.  Each  lateral  tooth,  however,  is  supported  by  the 
central,  and  represents  the  second  stone  upon  the  anterior 
base.     The  teeth  which  next  appear  are  the  first  bicuspids. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  407 

Immediately  following  are  the  second  bicuspids,  which  repre- 
sent the  second  and  third  stones  upon  the  posterior  bases. 
The  arches  are  then  complete,  except  the  key-stones — the 
cuspid  teeth.  These  cannot  be  omitted,  for  they  bind  and 
hold  the  teeth  together  and  give  beauty  and  shape  to  the 
arches.  The  follicles  of  these  teeth  are  originally  situated 
outside  of  and  above  the  crown  and  roots  of  the  teeth  already 
in  the  arch,  which  results  in  a  larger  circle;  and  because  these 
teeth  have  long,  powerful  roots,  unusual  power  and  leverage 
is  given  them.'  For  this  reason  they  are  directed  downward 
and  inward,  their  crowns  being  so  located  that  the  lips  assist 
greatly  in  aiding  the  downward  movement  of  these  teeth. 
The  downward  and  inward  movement  of  the  cuspids  is  simi- 
lar to  the  lowering  of  the  key-stone  in  an  arch;  it  continues 
to  move  downward  until  it  meets  with  an  obstruction,  which 
may  be  confined  to  the  upper  jaw  and  include  the  teeth  ante- 
rior and  posterior  to  the  cuspid.  If  the  teeth  in  position  are 
in  harmony  with  the  jaw,  the  cuspids  will  descend  into  their 
proper  places  and,  touching  the  teeth  on  each  side,  lock  the 
arches  and  hold  the  teeth  in  proper  position. 

Let  us  examine  the  arches  with  their  bony  encasements, 
and  ascertain  what  the  bases  are  resting  upon,  the  relative 
strength  and  support  of  each  base,  and  the  relative  strength 
of  the  anterior  and  posterior  columns.  In  the  posterior  parts 
of  the  mouth  the  alveolar  process  is  very  thick,  and  the  base 
— the  first  permanent  molar — is  large,  having  three  roots  in 
the  upper  jaw  and  two  in  the  lower,  curved  and  so  arranged 
in  the  alveolar  process  as  to  preclude  its  going  backward. 
We  also  find  other  teeth  of  nearly  equal  strength  posterior  to 
the  first  permanent  molars.  Anterior  to  the  base — the  first 
permanent  molar — we  find  the  first  and  second  bicuspids: 
these  teeth  are  all  firmly  imbedded  and  situated  in  the  long 
axes  of  the  alveolar  process,  forming  together  a  very  firm 
base.  The  anterior  column  of  the  arch  consists  of  but  two 
teeth,  while  the  posterior  column  has  five.  The  anterior  teeth 
possess  single  roots,  and  are  situated  crosswise  in  a  very  thin 
alveolar  process,  thus  demonstrating  the  comparative  weak- 
ness of  the  anterior  arch.      In  some  instances  the  space  may 


408 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


be  too  large  in  the  superior  arch,  and  the  key-stone  or  cuspid 
tooth  may  continue  in  its  downward  course  till  it  engages 
with  the  the  teeth  in  the  lower  jaw, 

DESCRIPTION  OF   THE  V-SHArED  ARCH    AND  ITS    MODIFICATIONS. 

The  V-shaped  arch  presents  a  triangular  outline  (Fig.  141), 
the  apex  of  the  triangle  being  formed  by  the  central  incisors 
where  the  process  is  usually  bent  so  that  the  incisors  form  an 
angle  instead  of  being  in  line.  From  this  apex  the  lateral 
halves  are  in  a  straight  hne  terminating  at  the  first  molars;  a 
line  connecting  them  forms  the  base  of  the  triangle.  The 
cause  of  this  peculiar  outline  is  a  want  of  correspondence 
between  the  size  of  the   jaw  and  teeth,   or  the  premature 


Fig. 141. 

extraction  of  the  temporary  molar,  or  both  causes  combined, 
thus  allowing  the  first  permanent  molars  to  move  forward. 
When  the  rest  of  the  permanent  teeth  come  in  they  do  not 
find  room  and  are  thus  crowded  together;  the  process  must 
give  way  in  order  to  adapt  the  greater  arch  formed  by  the 
crowns  of  the  teeth  to  the  lesser  arch  of  the  maxilla.  The 
point  of  fracture  is  in  or  near  the  median  line,  since  the  pro- 
cess is  thinnest  at  this  point.  The  illustrations  given  here 
show  varieties  of  this  type.  By  comparing  each  one  with  the 
diagram  it  will  be  seen  that  they  all  are  triangular  in  outline, 
Fig.  144  being  the  best  representation  of  this  form  of  irreg- 
ularities. A  line  passing  from  the  median  line  of  the  central 
incisors  through  the  cutting  edges  and  crowns  is  straight. 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


409 


The  study  of  the  cases  here  given  shows  the  result  of  the  for- 
ward movement  of  the  first  molar.  The  subsequent  loss  of 
teeth,  the  peculiarity  of  articulation,  and  the  thinness  of  the 
process  at  certain  points  determine  the  modifications.  In  Fig. 
142  it  will  be  noticed  the  laterals  are  gone;  for  this  reason 


Eig.  142. 


Fig.  143. 

the  centrals  are  still  in  line,  space  having  been  made  by  the 
absence  of  the  laterals;  Fig.  143  shows  by  its  overlapping 
centrals  that  there  was  want  of  space  at  the  time  of  their 
eruption;  the  loss  of  the  second  bicuspids  subsequently, 
together  with  peculiarities  of  articulation,  have  permitted  the 


410 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES    OF 


lateral  halves  to  assume  some  curvature.  Fig.  144  shows  an 
arch  too  small  for  the  teeth,  and  is  destitute  of  the  right  first 
molar  and  the  left  first  bicuspid.  These  were  evidently  lost 
after  the  central  incisors  were  erupted.  The  rest  of  the  teeth 
have  migrated  more  or  less  because  not  kept  in  place  by  close 
articulation.     Thus  the  cuspids  are  kept  out  of  place,  and  by 


Fig.  144. 


Fig.  145. 

their  pressure  inward  tend  still  more  to  narrow  the  arch 
anteriorly.  In  Fig.  145  the  centrals  are  spread,  though  the 
process  is  evidently  bent.  This  spreading  is  accounted  for 
by  the  absence  of  the  right  lateral,  which  has  allowed  the  cen- 
tral to  move  backward  and  the  cuspid  to  move  in.  On  the  left 
side  we  see  the  cuspid  erupted  inside  of  the  arch.' 

Modifications  of  the  V-shaped  arch  result  from  modifica- 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


411 


tions  of  the  above-named  conditions.  A  difference  in  the 
time  of  eruption  of  the  cuspids,  everything  else  being  equal, 
effects  a  difference  in  the  space  left  for  their  accommodation, 
and  thus  partial  V-shaped  arches  are  found.  The  key-stone 
(the  cuspid)  is  not  entirely  outside  or  inside  of  the  arch  in  the 
partial  V-shaped  form,  but  may  appear  partially  crowded  out 


Fig.  146. 


Pig.  147. 

of  place.  Hence  the  arch  is  neither  a  normal  curve  nor 
wholly  angular,  but  unites  the  characteristics  of  both.  Its 
lateral  diameter  is  less  than  that  of  the  normal  arch,  giving 
it  a  contracted  appearance.  (See  Fig.  146.)  Thus  a  number 
of  varieties  of  the  fundamental  forms  of  the  V-shaped  arch 
are  formed,  differing  in  degrees  of  anterior  contraction.     All 


412  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

of  these  result  from  the  comparative  thinness  of  the  anterior 
portion  of  the  process  oti'ering  but  little  resistance,  an 
abnormal  ^u'essure  from  behind,  and  the  greater  strength  of 
the  cuspids,  which  causes  them  to  seek  room  irrespective  of 
the  space  left  for  them.  By  drawing  a  perpendicular  line 
from  the  median  line  of  the  central  incisors  to  the  base,  and 
comparing  the  halves  thus  obtained  with  our  diagram,  we 
see  that  the  right  half  in  Fig.  147  is  partially  V-shaped,  while 
the  left  is  normal.  Near  the  apex  we  have  the  crowded  con- 
dition of  the  incisor,  overlapping  the  lateral;  from  thence 
back  the  curve  of  the  arch  is  lost.  The  absence  of  the  first 
bicuspid,  together  with  the  want  of  proper  articulation,  has 


Fig.  148. 

allowed  the  cuspid  to  press  hearer  the  center  of  the  palate 
than  is  normal. 

In  Fig.  148  the  V-shape  is  not  so  apparent,  but  the  central 
incisors  are  crowded,  which  shows  that  there  is  not  perfect 
harmony  between  size  of  teeth  and  jaw.  This  contracts  the 
anterior  arch. 

When  one  side  of  the  process  near  the  symphysis  is  the 
stronger,  thus  affording  greater  resistance,  or  the  pressure  of 
the  cuspid  is  less,  that  side  may  maintain  its  normal  relations 
while  the  other  may  give  way  to  conditions  resulting  in  a  V- 
shaped  contraction.  The  curve  will  then  be  broken,  not  at 
the  apex  of  the  triangle,  but  near  it;  the  incisors  will  overlap 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


413 


and  when  pressure  from  the  cuspid  acts  on  the  weaker  col- 
umn it  must  give  way.  Tliis  results  in  the  semi- V-shaped 
form.     (Fig.  150.) 

Fig.  151  illustrates  a  semi -V-shaped  arch.  The  teeth  in 
the  left  dental  arch  are  nearly  on  a  straight  line.  The  teeth 
in  the  right  dental  arch  are  situated  upon  a  slight  curve.      In 


Pig.  150. 


this  arch  the  cuspid  is  in  position,  while  upon  the  left  arch  it 
is  missing.  The  posterior  teeth  have  moved  forward  and 
filled  the  space  intended  for  the  cuspid.  It  is  still  located  in 
the  alveolar  process,  and  the  force  produced  by  the  inward 
pressure  of  the  cuspid  is  so  great  that  the  central  and  lateral 
incisors  have  been  carried  forward  and  the  teeth  and  alveolar 


4U 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


process  have  produced  the  straight  line.  The  lateral  press- 
ure of  the  teeth  prevents  their  being  carried  farther  inward. 
The  lack  of  proper  antagonism  of  the  central  incisors  has 
allowed  the  cuspid  to  force  the  incisor  and  alveolar  process 
forward  until  the  basilar  ridge  of  the  right  central  antago- 


Fig.  152. 


nizes  with  the  mesial  surface  of  the  left  central.      This,  in  a 
measure,  checks  the  progress  of  the  cuspid  inward  and  holds^ 
the  arch  on  a  slight  curve.     A  perpendicular  line  drawn  from 
the  mesial  surface  of  the  right  central  incisor  (Fig.  152)  to 
the  base  shows  the  left  side  to  be  V-shaped,  while  the  right 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


415 


is  normal.  In  Fig.  153  the  outline  does  not  so  clearly  point 
to  a  V-shaped  arch.  By  comparing  the  curvature  of  the  two 
halves  and  noting  the  position  of  the  right  cuspid,  it  is  more 
apparent.  The  bending  of  the  process  at  the  mesial  line  is 
evident  from  the  position  of  the  right  central.  This  has 
turned  upon  its  axis  from  want  of  lateral  antagonism  and 
proper  occlusion.  This  partial  rotation  has  allowed  the  lat- 
eral to  move  back,  occupying  in  part  the  space  of  the  cuspid, 
which  has  forced  the  cuspid  out  of  its  normal  position,  caus- 
ing it  to  erupt  outside  of  the  arch. 

Fig.  154  shows  a  combination  of  semi-V  and  partial  V- 


Fig.  154. 


shaped  arches.  The  cuspid  being  outside  of  the  left  arch  con- 
tracts it  and  gives  it  the  characteristics  of  the  V-shape.  On 
the  right  side  the  cuspid  is  partially  crowded  out  of  place,  and 
the  arch  is  somewhat  contracted. 


IRREGULARITIES    OF   THE    LOWER   JAW. 

The  lower  jaw  never  assumes  the  V-shape  when  the  teeth 
articulate  normally,  because  the  anterior  inferior  teeth  nor- 
mally close  inside  of  the  upper  teeth,  and,  while  the  force 
from  improper  occlusion  of  the  jaws  and  the  forward  move- 
ment of  the  posterior  lower  teeth  is  as  great  or  greater  than 


416  ETIOLOGY  OF  OSSEOUS  DEFOKMITIES   OF 

the  like  force  exerted  upon  the  upper  jaw,  the  forward  move- 
ment of  the  central  incisors  is  prevented  by  the  striking  of 
their  anterior  surfaces  against  the  posterior  surfaces  of  the 
superior  incisors.  There  are  many  irregularities  of  the  ante- 
rior inferior  teeth  caused  by  the  forward  pressure  of  the  pos- 
terior teeth.  These  are  quite  difficult  to  regulate,  owing  to 
their  intimate  relations  with  the  superior  incisors.  The  infe- 
rior dental  arch  should  be  divided  into  the  right  and  left  lat- 
eral arches,  corresponding  to  those  of  the  superior  arch. 
The  pressure  produced  by  improper  articulation  and  the  for- 
ward movement  of  the  posterior  columns  (the  bicuspids  and 
molars)  is  exerted  on  each  lateral  half  independently,  like 
that  in  the  lateral  arches  of  the  upper  jaw.  Each  lateral  arch 
on  the  lower  jaw  has  its  posterior  base  (the  first  permanent 
molar),  an  anterior  base  (the  central  incisor),  and  the  same 
number  of  stones  in  position  upon  the  bases — the  same  key- 
stone— all  representing  the  same  number  of  teeth  as  are 
contained  in  the  superior  lateral  arches.  The  development  of 
each  inferior  lateral  arch  is  independent  of  the  other,  as  is  the 
case  with  the  superior  lateral  arches.  The  irregularities  of 
the  teeth  in  each  lateral  arch  are  independent  of  the  others. 
When  the  posterior  column  moves  forward,  if  the  key-stone 
(the  cuspid  tooth)  is  retarded  or  slow  in  coming  into  place, 
the  space  is  filled  by  the  first  bicuspid  and  the  cuspid  remains 
outside,  precisely  as  in  the  superior  lateral  arches.  If  the 
pressure  of  the  posterior  columns  and  the  key-stone  is  uni- 
form, the  force  will  be  exerted  against  the  anterior  base  and 
the  first  stone  upon  the  base  (the  central  and  lateral  incisor). 
In  this  case  a  diflferent  condition  exists.  The  anterior  base 
and  first  stone  of  the  superior  lateral  arch,  and  the  anterior 
inferior  column,  resist  the  force.  Occasionally,  this  is  so 
great  that  the  anterior  columns  of  both  superior  and  inferior 
dental  arches  are  carried  forward.  When  this  occurs,  the 
incisors  upon  the  upper  jaw  protrude.  When  the  forward 
movement  of  the  posterior  column  occurs,  the  incisor  (or 
anterior  column)  will  crowd  past  one  another  like  the  sticks 
of  a  fan,  provided  the  pressure  be  uniform  in  both  lateral 
arches.     The  six  teeth  which  are  instrumental  in  the  con- 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


417 


struction  of  these  deformities  are  illustrated  in  Fig.  155. 
These  teeth,  as  will  l)e  observed,  are  wedge-shaped;  their 
points  of  contact  are  at  their  cutting  edges;  slight  oblique 
pressure  will  cause  these  teeth  to  lap  over  each  other.  If 
the  pressure  is  upon  one  side  only,  the  irregularity  will  be 
located  on  that  side.  One  of  the  common  irregularities  is 
seen  when  the  key-stone  or  cuspid  tooth  is  slow  in  erupting. 
The  posterior  column  moves  forward  3,nd  the  resistance  of 
the  anterior  column  forces  the  key-stone  outside  the  arch.  It 
sometimes  happens  that  the  key-stone  moves  into  place  and 


Fig.  155. 


Pig.  156. 


is  held  in  position  by  the  anterior  column,  and  the  second 
stone  upon  the  posterior  column  (the  first  bicuspid)  is  carried 
forward  outside  the  arch.  This  theory  can  be  better  under- 
stood by  examining  cases  of  this  kind  which  are  found  in  my 
models  of  the  jaws  and  teeth,  and  which  will  be  illustrated 
later.  It  may  be  well  first  to  glance  at  Fig.  156,  which  shows 
in  position  a  section  of  the  teeth  made  on  the  line  of  lateral 
antagonism.  It  will  be  observed  that  the  mesial  and  distal 
surfaces  are  convex,  and  the  points  of  contact  are  situated  at 
the  extreme  lateral  surfaces.  If  the  teeth  at  eruption  should 
not  touch  at  these  particular  points,  or  if  the  force  exerted 


41S 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


should  not  be  in  direct  line  with  these  points  of  contact,  the 
teeth  would  be  situated  upon  an  incline,  and  the  force  thus 
applied  would  readily  carry  the  teeth  one  way  or  the  other. 
Such  deformities  occur  more  frequently  with  the  incisor  and 
cuspid  than  with  the  posterior  teeth.    The  posterior  teeth  are 


Fig.  158. 

held  in  position  by  their  contact  with  the  occluding  teeth  of 
the  opposite  jaw,  while  the  incisors  do  not  occlude.  One 
marked  feature  of  these  irregularities  is  that  in  most  cases 
the  lateral  incisor  is  carried  inward  and  the  centrals  outward 
to  remain  in  position  in  one  or  both  lateral  arches.  These 
conditions  are  fully  illustrated  in  the  chapter  on  local  causes. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  419 

Fig,  157  shows  the  right  dental  arch  as  normal.  In  the  left 
dental  arch  the  anterior  column  with  the  cuspid  (the  key- 
stone) has  moved  forward,  and  the  lateral  incisor  is  carried 
inward.  This  is  explained  when  the  relation  between  the 
mesial  surface  of  the  cuspid  and  the  distal  surface  of  the  lat- 
eral is  understood.  In  the  forward  movement  of  the  cuspid 
the  lateral  impinges  upon  a  markedly  inclined  plane  upon  the 
mesial  surface  of  the  cuspid,  and  the  forward  pressure  carries 
the  lateral  inward.  Fig.  158  shows  the  same  irregularity  in 
both  right  and  left  lateral  arches,  the  pressure  being  uniform 
upon  each  arch.  The  centrals  are  also  slightly  rotated  in 
their  sockets.  This  is  produced  by  the  flat  lateral  surfaces  of 
the  roots  meeting  and  the  pressure  of  the  crowns  against  the 
basilar  ridges  of  the  superior  centrals. 

THE    SADDLE-SHAPED    ARCH. 

The  saddle-shaped  arch  is  not  so  common  a  deformity  as 
the  V-shaped.  It  has  many  of  the  peculiarities,  however, 
that  are  seen  in  the  V-shaped  arch.  It  may  include  one  or 
both  lateral  arches.  It  may  be  partial  on  one  side  and  marked 
upon  the  other.  It  may  involve  the  bicuspids  and  first  per- 
manent molars  upon  one  side,  or  but  a  single  tooth  on  the 
other.  Each  lateral  arch  produces  its  own  deformity  inde- 
'pendently  of  the  other.  The  roof  of  the  mouth  may  be  high 
or  low.  The  deformity,  like  the  V-shaped  arch,  is  favored  by 
the  high  arch.  The  following  illustration  (Fig.  159)  shows 
the  manner  of  the  production  of  this  deformity.  We  see 
here  a  right  and  left  superior  lateral  arch  of  stone,  each  stone 
corresponding  in  size  and  location  to  the  natural  teeth.  The 
left  lateral  stone  arch,  corresponding  to  the  left  superior 
dental  arch,  shows  the  formation  of  the  saddle-shaped  arch 
and  the  order  of  laying  the  stones  and  changing  the  base. 
The  first  stone  laid  in  the  arch  corresponds  to  the  first  per- 
manent molar,  and,  like  the  stone  in  the  V-shaped  arch,  is 
denominated  the  posterior  base.  The  next  stone  laid  cor- 
responds to  the  central  incisor,  then  the  stone  which  stands 
for  the  lateral  incisor.  The  natural  order  then  changes,  and 
the  next  stone    laid   corresponds   to   the  key-stone   of  the 


420 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


V-shaped  arch  (the  cuspid).  It  becomes  the  anterior  base, 
forming  a  fixed  point  in  the  anterior  part  of  the  mouth.  The 
next  stone  laid  corresponds  to  the  first  bicuspid,  followed  by 
those  representing  the  second  bicuspid  and  the  second  and 
third  molars.  The  stones  being  in  position,  we  find  that  the 
anterior  and  posterior  columns  are  nearly  equal  in  strength 
and  resisting  power.  The  anterior  column  is  made  up  of  the 
anterior  base  (the  cuspid),  with  its  long  root,  backed  up  by 
two  foundation-stones,  representing  the  central  and  lateral 
incisors.  The  posterior  column  is  made  up  of  its  base,  the 
first  permanent  molar,  backed  by  two  foundation-stones,  rep- 


Fig.  159. 

resentins:  the  second  and  third  molars.  The  forward  move- 
ment  of  the  posterior  column  takes  place  in  the  arch  from  the 
same  causes  which  produce  the  forward  movement  in  the 
V-shaped  arch.  The  stone  representing  the  cuspid  is  not  the 
stone  involved;  it  is  almost  always  fixed  in  its  proper  place. 
The  weaker  stones  are  those  which  correspond  to  the  bicus- 
pids, and  they  are  the  stones  which  are  always  displaced 
when  the  forward  movement  of  the  posterior  column  occurs. 
The  change  in  the  order  of  the  laying  of  the  stones — i.  e.,  the 
stones  corresponding  to  the  cuspid  instead  of  the  bicuspid  (it 
being  irregular) — accounts  for  there  being  fewer  saddle  than 
V-shaped  arches.     The  change  of  the  anterior  base  will  also 


THE  HEAD,  FACE,  JAWS  AND  TEETH         421 

explain  why  the  anterior  column  and  alveolar  process  do  not 
project,  as  in  the  case  of  the  V-shapcd  arch.  The  right 
superior  lateral  arch  illustrates  another  common  variety  of  the 
saddle-shaped  arch.  It  does  not  difi'er  materially  from  the 
left  lateral  arch  as  regards  the  order  of  laying  the  stones.  The 
anterior  base  is  transferred  one  stone  back,  the  stoae  corre- 
sponding to  the  first  bicuspid.  The  posterior  base  remains 
the  same.  The  posterior  column  moves  forward  and  carries 
the  stone  representing  the  second  bicuspid  inward.  By  com- 
paring the  shapes  of  the  natural  teeth  with  the  stones  in  the 
arch  just  described,  we  shall  observe  that  the  approximate 
surfaces  are  convex  instead  of  flat  like  those  of  the  stone  arch 


Pig  160. 


just  described.  The  peculiar  incline  of  the  anterior  surface 
of  the  first  permanent  molar  and  the  posterior  surface  of  the 
cuspid  tooth,  together  with  the  oval  shapes  of  the  bicuspids, 
are  singularly  well  adapted  to  cause  these  irregularities  upon 
the  application  of  force.  The  first  permanent  molars  are 
situated  farther  outside  in  the  arch  than  any  teeth  posterior 
to  them.  The  cuspids  occupying  such  a  prominent  position 
in  the  arch,  in  the  anterior  part  of  the  mouth,  the  least  devia- 
tion inward  of  the  bicuspids  would  give  the  pinched  appear- 
ance of  the  jaw  at  that  locality.  In  neurotics  and  degenerates 
the  jaws  will  in  some  cases  develop  in  length  and  not  in  width. 
In  such  cases  the  jaws  at  the  sixth  and  seventh  year  remain 
permanent.      The    temporary  molars  hold    the  permanent 


422  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

l)icuspi(ls  in  the  undeveloped  position,  and  the  cuspids  erupt 
outside  the  arch.  In  this  way  a  full  saddle  is  formed.  This 
deformity  is  caused  also  by  the  too  early  extraction  of  tem- 
porary molars,  which  allows  the  first  permanent  moJars  to 
work  forward  and  force  the  bicuspids  inward,  or  by  the  reten- 
tion of  the  temporary  molars  or  their  roots,  thus  deflecting 
the  crowns  of  the  bicuspids.  The  question  arises,  why  are 
not  the  bicuspids  forced  outward  as  well  as  inward  ?  I  would 
reply  that  they  do  occur  frequently  outside  the  arch;  I  have 
several  among  my  collection  of  models.  The  inward  move- 
ment, however,  is  the  natural  one,  because  the  crowns  when 
in  the  jaw  are  situated  between  the  roots  of  the  temporary 
molars.  The  temporary  molars  are  situated  upon  a  smaller 
circle  than  the  permanent  molars  and  cuspids  (see  Fig.  160). 
When  the  temporary  molars  are  extracted,  the  crowns  of  the 
bicuspids  are  in  the  radius  of  a  smaller  circle,  while  their 
roots  have  been  carried  outward  by  the  development  of  the 
jaw  and  alveolar  process. 

The  molars  in  the  saddle  and  semi-saddle-shaped  arches  of 
the  upper  jaw  frequently  diverge  laterally.  If  the  case  shows 
a  semi-saddle-shaped  arch,  the  divergence  is  on  the  side  of  the 
deformity.  If  both  lateral  arches  are  involved,  both  sides 
diverge.  Cases  having  the  deformity  most  prominently  have 
the  most  marked  divergence.  When  a  slight  change  exists 
only  at  the  bicuspid  region^  the  divergence  in  the  molar 
region  is  slight.  This  peculiar  arrangement  of  the  molar 
teeth  may  be  due  to  two  causes:  First,  the  teeth  upon  the 
lower  jaw  diverge  on  account  of  the  shape  of  the  inferior  max- 
illa; the  farther  removed  from  the  incisors,  the  greater  the 
distance  between  the  molars  of  the  opposite  side.  The  molars 
upon  the  upper  jaw  usually  articulate  with  those  upon  the 
lower  jaw.  The  disparity  in  the  appearance  of  the  normal 
position  of  the  teeth  and  those  above  described  is  due  to  the 
pinched  condition  in  the  bicuspid  and  first  molar  region  rather 
than  to  the  position  of  the  molars.  Second,  when  the  arch  is 
contracted  at  the  bicuspid  region  the  tongue  is  limited  in  its 
movements.  In  swallowing,  the  tongue  goes  to  the  roof  of 
the  mouth  and  is  then  forced  backward  for  lack  of  room,  thus 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


423 


shortening  and,  consequently,  broadening  its  surface.  The 
result  of  the  lateral  expansion  would  naturally  be  to  force  the 
teeth  and  alveolar  process  outward. 

The   position  of   the   temporary  molars  determines   the 
position  of  the  bicuspids.  This  position  shows  the  diameter  of 


Fig.  161. 


Ficr.  162. 


the  jaw  early  in  life.  From  that  time  until  the  eruption  of 
the  third  molar,  i.  e.,  from  the  third  to  the  twentieth  year — 
the  jaw  has  an  opportunity  to  develop,  which  naturally  car- 
ries the  alveolar  process  and  teeth  out  laterally,  causing  the 
crowns  of  the  third  molar  to  face  the  cheek  in  some  instances, 


424 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


DESCRIPTION   OF  THE   SADDLE-SHAPED   AKCH   AND   ITS  MODI- 
FICATIONS. 

When  there  is  harmony  between  the  size  of  the  teeth  and 
that  of  the  arch,  and  the  permanent  bicuspids  erupt  under 
favorable  conditions,  so  that  their  greatest  diameter  is  in  a 
line  with  the  greatest  diameter  of  both  first  cuspid  and  molar, 


Fig.  1B3. 


Fig.  164. 

they  will  be  held  firmly  in  place,  since  the  greatest  pressure 
is  on  this  very  line.  On  the  other  hand,  when  the  bicuspids 
arc  erupted  aftei'  their  proper  time,  while  the  cuspids  pro- 
gress duly,  the  cuspids,  meeting  with  no  resistance,  fall  into 
their  natural  position,  while  the  bicuspids  erupt  inside  of  the 
arch,  forming  an  angle.     This  angle  results  from  two  causes 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


425 


Fig.   167 


426  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

— the  thinness  of  the  process  at  this  point  and  the  diminution 
of  resistance  which  must  follow. 

Fig.  1G2  shows  a  decidedly  saddle-shaped  arch.  The  max- 
illary^ bone  is  too  narrow  at  its  anterior  extremity  for  the 
teeth,  which  are  suited  to  a  more  expanded  jaw.  The  consti- 
tutional tendency  to  this  deformity  is  quite  apparent  in  this 
case.  The  vault  is  high  and  narrow.  The  first  molars  are 
pushed  forward,  leaving  only  sufficient  space  on  each  side  for 
one  bicuspid.  These  are  therefore  turned  inward  toward  the 
palate,  making  the  vault  at  this  point  still  narrower  than  it 
naturally  is. 

When  the  unfavorable  conditions  that  result  in  the  saddle- 
shaped  arch  are  not  so  pronounced,  we  have  the  partial  saddle- 
shaped  arch.  Thus,  because  of  the  greater  uniformity  of  the 
maxilla  and  of  the  arch  of  the  crowns  there  may  be  more 
space,  and  the  bicuspids  may  be  forced  but  little  out  of  place, 
or  the  molar  may  move  forward  but  slightly,  interfering  less 
with  the  bicuspids.  Sometimes  it  happens  that  in  trying  to 
adjust  themselves  to  the  limited  space  one  bicuspid  may  be 
crowded  outv^rard  and  another  inward.  Sometimes  the  first 
bicuspid  is  in,  more  frequently  the  second.     (Fig.  164.) 

Figs.  165  and  166  show  a  normal  arch  on  the  left  side,  and 
a  saddle-shaped  arch  on  the  right.  The  vault  is  normal  in  this 
case;  hence  there  is  more  room  for  the  erupting  bicuspids,  and 
less  curvature  results  than  is  found  in  Fig.  164.  Fig.  167 
shows  a  similar  condition  of  the  left  side. 

COMBINATION    OF   V    AND     SADDLE-SHAPED    ARCHES. 

How  the  V-shaped  and  saddle-shaped  arch  on  one  side 
only  may  be  produced  has  already  been  described.  How  they 
maybe  combined  on  one  side  remains  to  be  explained.  Given 
thinness  of  process  in  the  anterior  part  of  the  mouth,  prema- 
ture or  tardy  extraction  of  the  first  molar,  and  there  will  be  a 
forward  movement  of  the  incisors.  The  development  of  the 
cuspid  will  press  the  alveolar  process  inward,  thereby  con- 
tracting the  arch,  and  the  tardil}'^  erupted  bicuspids  will  adjust 
themselves  to  the  limited  curve  as  before  stated.  In  this  way 
the  features  of  the  two  forms  are  combined;  that  is,  a  con- 


THE  HEAD,  FACE,  JAWS  AND  TEETH 


427 


tracted  or  angular  anterior  arch,  and  a  posterior  arch  that  is 
more  or  less  concave.  The  opposite  side  may  be  V-shaped, 
saddle-shaped  or  normal.     (Figs.  168  and  170.) 

Fig.   169  shows  a'  combination  of  V  and  saddle-shaped 
arch  on  the  left  side  and  V-shaped  on  the  right.     Figs.  170 


Fig.  168. 


Pig.  169. 

and  171  is  a  case  of  semi-V  and  semi-saddle-shaped  arches 
combined. 

Fig.  172  shows  a  semi-saddle  shape  in  the  right  lateral  arch ; 
the  second  bicuspid  has  been  forced  inside  the  arch.  The 
opposite  side  shows  a  condition  exactly  reversed.  The  points 
of  lateral  antagonism  of  the  second  bicuspid  are  outside  the 


428  ETIOLOGY  OF  OSSEOUS  DEFORMITIES   OF 


Fig.  170. 


Fig.  171. 


Fig.  172. 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


429 


long  diameter  of  the  dental  arch.  The  anterior  movement 
of  the  posterior  base  forced  the  tooth  outward.  The  tendency 
of  this  irregularity  was  to  form  the  V-shaped  variety.  The 
irregularity  of  the  left  lateral  arch  (Fig.  173)  is  a  common  one. 


Fig.  173. 


Fig.  174. 


The  teeth  develop  normally,  but  the  second  bicuspid  is  either 
retarded  in  its  development  or  it  is  deflected  inward  by  some 
local  cause.  The  anterior  base  is,  in  this  case  transferred  to  the 
first  bicuspid.  The  posterior  and  anterior  bases  come  together, 


430  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

and  the  second  bicuspid  is  crowded  inward.  The  irregularity 
corresponds  to  the  right  lateral  stone  arch  of  Fig.  159. 

THE  SADDLE-SHAPED  ARCH  OF  THE  LOWER  TEETH. 

The  saddle-shaped  arch  on  the  lower  jaw  is  generally  due 
to  local  causes,  the  retention  of  the  temporary  molars  being 
one  of  them.  The  one  illustrated  is  the  result  of  both  local 
and  constitutional  causes.  This  deformity  is  also  due  to  an 
arrest  of  lateral  development  of  the  lower  jaw. 

Fig.  174:  illustrates  a  saddle-shaped  irregularity  upon  the 
lower  jaw.  The  impression  is  from  the  jaw  of  a  man  fifty-six 
years  of  age;  the  second  molars  w^ere  extracted  at  the  age  of 
twenty-two.  The  irregularity  was  produced  at  the  time  of 
the  development  of  the  teeth.  The  teeth  are  large  and  firmly 
set  in  the  powerful  jaws.  Asymmetry  of  the  jaws  exists.  If 
they  had  developed  in  unison,  this  deformity  would  have 
been  prevented.  The  forward  movements  of  the  posterior 
columns  have  carried  the  cuspids  forward  and  the  lateral 
incisors  inward,  so  that  the  cuspids  and  centrals  stand  on  a 
line.  The  second  bicuspids  and  first  permanent  molars  have 
been  forced  inward  by  the  inclined  plane  formed  by  the  poste- 
rior surfaces  of  the  first  bicuspids,  and  also  by  the  articulation 
of  the  superior  teeth,  which  form  a  smaller  arch  than  the  lower 
teeth.  As  will  be  seen,  the  third  molars  have  moved  forward 
and  nearly  filled  the  spaces  made  vacant  by  the  extraction  of 
the  second  molars.  This  forward  movement  was  no  doubt 
due  to  improper  articulation  with  the  upper  teeth. 


CHAPTER  XXXIII. 

LOCAL  CAUSES  OF  IRREGULARITIES  OF  THE 
TEETH— UPPER  JAW. 

A  local  cause  resulting  in  an  irregularity  is  found  in  mal- 
position and  malocclusion  of  individual  teeth  as  a  result  of 
an  accident,  such  as  premature  or  tardy  extraction  of  tem- 
porary teeth,  or  malposition  and  malocclusion  growing  out  of 
constitutional  causes. 

Before  taking  up  each  form  of  the  irregularity  to  which 
an  individual  tooth  is  subject,  a  few  words  should  be  said 
about  the  relative  influence  and  force  of  teeth,  for  on  this 
these  irregularities  in  a  great  measure  depend. 

RELATIVE    IMPORTANCE    OF   INDIVIDUAL   TEETH    IN    EFFECTING 
IRREGULARITIES. 

Foremost  in  influence  on  the  relative  position  of  per- 
manent teeth  is  the  first  molar.  If  the  temporary  molar  is 
extracted  prematurely  the  forward  movement  of  the  posterior 
column  follows  it,  the  expanse  of  the  anterior  column  pro- 
ducing more  or  less  vicious  position,  relation  and  occlusion. 
I  have  frequently  observed  the  anterior  movement  of  the 
temporary  molars  and  cuspids  as  well  as  the  permanent  bicus- 
pids and  cuspids,  from  the  great  force  exerted  by  the  first 
permanent  molar,  and  have  a  number  of  models  showing 
same.  To  this  even  the  cuspid  must  yield,  though  most 
influential  in  the  anterior  column.  Next  to  the  first  perma- 
nent molar  in  importance  is  the  cuspid.  It  asserts  itself  above 
the  rest  because  of  its  vital  force,  length  of  root,  peculiar 
shape  and  location  in  the  jaw.  The  length  of  its  root  allows 
it  to  deviate  more  than  any  other  tooth  from  its  original  posi- 
tion, because,  with  the  same  degree  of  pressure  brought  to 
bear  on  or  near  the  apex  of  its  root,  a  tooth  may  diverge  in 
proportion  to  the  length  of  its  root;  though  the  angle  is  the 
same,  the  divergence  grows  greater  the  farther  the  cusp  is 
from  the  apex. 


432  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

The  central  incisor  comes  next  in  importance,  and  then 
the  lateral.  The  central  incisor  tinds  a  support  in  its  fellow 
on  the  opposite  side,  while  the  lateral  is  the  most  passive  of 
teeth.  It,  however,  plays  the  part  of  a  co-ordinating  force, 
since  without  this  wedge  the  teeth  are  not  retained  in  their 
position,  and  occlusion  is  disturbed.  Because  of  its  weakness 
and  short  root  it  is  very  easily  displaced. 

THE    CENTRAL    INCISOR — IRREGULARITIES    PRODUCED    BY    THE 

MALPOSITION    OF  CENTRAL    INCISORS  RESULTING  FROM 

FLEXION    OF    THE     ALVEOLAR    PROCESS. 

In  the  chapter  on  general  classes  of  irregularities  the 
fact  was  emphasized  that  the  forward  movement  of  the  pos- 
terior column — i.  e.^  the  bicuspids  and  molars  due  to  prema- 
ture or  tardy  extraction — will  force  the  weaker  anterior 
column  and  alveolar  process  forward.  The  pressure  brought 
to  bear  upon  it  from  both  sides  makes  the  arch  of  the  upper 
maxilla  greater  than  that  of  the  lower.  As  a  consequence 
occlusion  will  be  wanting  or  defective  and  flexion  must  take 
place  according  to  the  position  assumed  in  the  eruption  of 
each  individual  tooth.  This  condition  is  greatly  promoted 
by  the  pressure  of  the  cuspids,  which,  in  coming  down,  assert 
themselves  at  the  expense  of  the  weaker  incisors.  But  this 
is  not  all.  Much  depends  on  the  size  and  the  development  of 
the  germs  of  the  permanent  incisors.  When  there  is  strong 
vitality  their  size  may  be  out  of  proportion  to  that  of  the 
alveolar  process.  Owing  to  healthy  nutrition  or  the  nature 
of  the  food  that  is  taken  into  the  system  during  the  time  of 
their  development,  the  centrals  may  become  very  vigorous. 
This  more  than  ordinary  development  shows  itself  not  so 
much  in  the  relative  position  of  the  axes,  but  in  the  irregu- 
larities of  the  cutting  edges,  owing  to  the  excessive  diameters 
of  these,  which  causes  them  to  overlap  slightly.  When  a 
temporary  incisor  persists  too  long  in  its  socket,  the  germ  of 
the  permanent  tooth  is  embarrassed  in  its  eruption.  The 
germ  seeks  its  way  out  as  best  it  can,  and  as  projecting  in 
a  straight  line  is  out  of  th^  question,  it  slips  around  the  tem- 
porary teeth   and  is   forced  partially  out  of  position.     The 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


433 


process  in  this  case  is  not  unlike  that  of  the  germ  of  a  plant 
that  forces  its  way  out  from  under  a  stone. 

Having  considered  the  cause  of  the  irregularities  of 
this  division,  we  will  now  proceed  to  consider  its  varieties. 
A  form  frequently  met  with  is  found  in  V-shaped  arches.  The 
central  incisors  are  crowded  together  so  that  their  cutting 
edges  are  not  in  a  line,  but  form  an  angle  that  points  for- 


Fig.  175. 


Fig.  176. 


< 


-.    '      ; 


.    \ 


^) 


Fig.  177. 


Fig.  178. 


Fig.  179. 


ward.  (Fig.  175.)  This  is  the  most  natural  form  for  the 
flexion  to  assume.  The  arch  is  simply  broken  in  front,  fol- 
lowing the  general  direction  of  the  pressure.  The  mesial  sur- 
faces are  parallel;  the  anterior  angle  points  forward,  follow- 
ing the  general  law  of  incisors.  The  force  is  uniform.  Had 
the  anterior  column  not  been  forced  forward  by  the  posterior 
'  one,  these  teeth  would  be  normal  in  every  respect.  Some- 
times  we   find   them   overlapping   each  other  slightly,  and 


434:  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

occasionally  the  anomaly  is  met  with  that  the  general  axes  of 
the  teeth  do  not  converge,  but  diverge.  This  divergence  is 
found  to  be  due  to  a  fault}'  occlusion,  the  lower  incisors  act- 
ing as  a  wedge,  driving  the  upper  incisors  apart,  or  else,  from 
a  want  of  occlusion,  they  follow  their  course  without  guid- 
ance and  support. 

In  the  second  class,  where  the  cutting  edges  form  an 
angle  which  is  directed  backward  (Fig.  176),  the  pressure  from 
behind  by  the  posterior  column  has  met  with  an  obstruction 
in  front.  This  obstruction  exists  in  the  center  of  the  alve- 
olar process,  and  is  strong  enough  to  resist  in  a  measure  the 
pressure  from  behind.  Hence  the  force  spreads  itself  on  the 
lateral  divisions  of  the  anterior  process.  The  result  is  that 
the  mesial  line  is  formed  behind  the  distal  line,  and  an  angle 
is  formed.  Here,  as  in  the  former  case,  occlusion  is  an 
important  factor  in  determining  the  position  of  the  axis.  A 
want  of  proper  occlusion  may  force  the  anterior  teeth  apart. 
The  laterals  also  in  seeking  their  natural  position  may  help  to 
force  the  distal  surfaces  of  the  central  incisors  still  more  out 
of  line.  Being  wedged  in  between  centrals  and  the  cuspid 
teeth,  the  latter,  by  their  greater  force,  cause  the  centrals  to 
yield  to  the  laterals  that  are  wedged  between  them.  The 
mesial  angle  of  the  laterals  infringes  upon  the  inner  surface 
of  the  distal  angle  of  the  centrals.  These  continue  to  rotate 
until  the  entire  mesial  surface  of  the  laterals  rests  against  the 
palatine  surface  of  the  centrals.  Then  the  rotation  naturally 
ceases,  the  laterals  forming  an  abutment.  Pressure  being 
exerted  on  both  centrals,  in  this  way  an  angle  is  formed,  and 
the  pressure  on  both  sides  being  equal,  they  are  not  thrown 
out  any  farther.  The  direction  of  the  cutting  edges  depends 
on  the  shape  of  the  teeth. 

If  the  diameters  of  the  cutting  edges  exceed  much  those 
of  the  necks,  they  necessarily  overlap  to  a  greater  extent. 

When  the  two  central  incisors  do  not  erupt  harmoniously, 
one  overlaps  the  other.  (Fig.  177.)  If,  in  addition  to  this  con- 
dition, the  force  that  is  l^rought  to  bear  on  the  anterior  alve- 
olar arch  is  very  unequal,  certain  modifications  occur.  An 
unequal  pressure  exerted  by  the  cuspids  in  their  eruption  will 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


435 


force  one  side  of  the  arch  farther  forward  than  the  other. 
When  the  first  molar  on  one  side  has  been  extracted,  while 
that  on  the  other  side  remains,  the  forward  movement  is 
necessarily  one-sided,  and  a  corresponding  irregularity  fol- 
lows. The  tardy  extraction  of  temporory  teeth  goes  far  in 
forcing  the  germs  of  the  permanent  teeth  out  of  place.  Irregu- 
larity in  the  lower  incisors  through  faulty  occlusion  modifies 
greatly  the  direction  of  the  upper  teeth. 

Sometimes  centrals  projecting  in  a  line  in  front  of  the 
laterals  are  met  with.  (Fig.  178.)  In  this  case  the  centrals 
erupted  properly;  but  the  arch  being  undeveloped,  there  is 
not  room  for  the  laterals.  These  are  carried  forward  by  the 
posterior  column  and  in  by  the  cuspids,  and  are  possibly 
driven  in  by  the  lower  incisors,  which,  instead  of  striking 


Fig.  180. 


within  them,  strike  without,  exaggerating  the  difllculty. 
When  this  is  not  the  case,  and  the  laterals  strike  outside  of  the 
lower  teeth,  the  upper  arch  is  too  large  for  the  lower,  and  the 
upper  centrals,  not  finding  the  proper  support  below,  are 
forced  out  in  a  similar  manner, 

A  similar  condition  is  that  in  which  the  central  incisors 
strike  within  the  laterals.  (Fig.  179.)  The  cause  is  the  same; 
but  the  laterals  in  erupting  fail  to  find  the  proper  support 
and  project  outward,  while  the  centrals  occlude  properly.  In 
this  case  the  upper  maxillary  arch  is  not  necessarily  too  large 
for  the  lower;  but  the  teeth  are  crowded. 

One  form  of  irregularity  that  is  occasionally  met  with 
is  that  which  gives  rise  to  a  right  angle  in  the  region  of  the 
cuspids,  the  incisors  being  in  a  straight  line.  (Fig.  ISO.) 
There  are,  of  course,  cases  of  this  kind  where  the  upper  and 


436  ETiOLOcr  of  osseous  deformities  of 

lower  arches  resemble  each  other,  and  where  the  occlusion  is 
fair,  which,  for  these  reasons,  cannot  be  classed  under  irregu- 
larities. When  this  rectangular  appearance  is  found  in  the 
upper  jaw  only,  it  is  evidently  due  to  a  flexion  in  the  region 
of  the  cuspids  caused  by  the  forward  movement  of  the  pos- 
terior column.  The  anterior  alveolar  column  will  be  found 
thick,  and  is  therefore  capable  of  resisting  the  pressure  of  the 
posterior  column,  and  the  pressure  is  spent  on  the  weakest 
point — i.  e.^  the  region  of  the  cuspid.  Hence  the  flexion  at 
this  point.  There  is  always  an  excessive  development  of  the 
upper  jaw  and  alveolar  process.  This  causes  the  teeth  to 
erupt  too  far  forward  for  occlusion  with  the  lower  arch,  and 
the  lip  draws  them  in  until  they  strike  the  lower  arch,  and 
the  long  axes  of  the  teeth  point  inward  instead  of  outward. 
Thus  the  vault  is  brought  forward,  leaving  the  lower  incisors 
without  support. 

IRREGULARITIES    PRODUCED  BY  THE    MALPOSITION    OF  CENTRAL 
INCISORS  DUE  TO  VICIOUS  ERUPTION, 

The  laws  that  govern  the  eruption  of  the  teeth  and  har- 
monize their  development  are  occasionally  interfered  with. 
The  germs  that  should  be  directly  over  the  temporary  inci- 
sors may  be  displaced.  These  should  be  situated  above  and 
anterior  to  the  temporary  teeth;  but  occasionally  the  germ  is 
situated  above  and  deflected  posteriorly,  and  thus  it  is  liable 
to  be  erupted  on  the  palatine  surface.  A  displacement  of  the 
germs  generally  results  in  vicious  eruption;  for,  however 
slight  it  may  be,  as  the  tooth  progresses,  the  line  of  its  axis 
must  diverge  more  and  more  from  that  of  its  normal  position. 
The  central  incisors  spring  from  a  point  farther  back  than  it 
should  be.  If  the  elevation  of  the  gum  is  followed,  it  will 
be  seen  that  these  two  diverge  more  and  more  toward  their 
cutting  edges.  Thus  the  relation  of  their  axes  is  changed 
entirely,  and  a  partial  rotation  is  produced.     (Fig.  181.) 

Again,  if  the  roots  of  the  temporary  teeth  persist  instead 
of  being  absorbed  as  the  permanent  teeth  advance,  they  mate- 
rially interfere  with  the  eruption  of  these,  and  are  apt  to  turn 
them  out  of  their  course.     When  one  of  the  conical  roots  of 


THE    HEAD,    FACE,    JAWS    AND    TEETH 


437 


the  incisors  infringes  upon  another  not  in  the  same  line,  as 
the  teeth  develop,  a  tendency  to  rotation  is  established  on  the 
principle  of  the  screw.  This  partial  rotation  upon  its  axis  is 
more  apparent  the  greater  the  diameter  of  the  tooth;  for  the 
cutting  edge,  usually  in  line  with  the  other  teeth,  now  par- 
takes of  the  revolution  of  the  axis,  and  so  forms  an  angle  with 
the  arch. 

In  these  three  cases,  when  the  tooth  is  fully  erupted  it 
finds  a  proper  resting-place  on  the  opposing  tooth;  its  mal- 
position may  be  corrected  by  the  exercise  of  its  proper  func- 
tion; but  it  often  fails  to  find  this,  and  projects  out,  being 
without  support. 

Adventitious  germs  appear  occasionally  in  the  alveolar 
process.  When  these  are  found  in  the  arch,  they  necessarily 
disarrange  the  occlusion  and  throw  the  teeth  out  of  their 


Fi2.  181. 


Fig.  182. 


proper  position.  Supernumerary  teeth  usually  appear  at  the 
median  line,  and  then  necessarily  crowd  all  the  teeth  later- 
ally. Frequently  one  supernumerary  tooth  is  found  exactly  in 
the  median  line,  and  centrals  coming  down  to  the  right  and 
left  in  the  arch. 

Occasionally  two  are  found  in  the  position  where  the  cen- 
trals should  be.  In  such  cases  the  central  incisors  are  gener- 
ally located  outside  and  anterior  to  the  lateral  incisors. 
When  a  supernumerary  is  found  outside  of  the  arch  in  the 
median  line,  one  central  may  be  in  position;  the  other  may  be 
thrown  out  or  in,  and  may  be  rotated  45°  upon  its  axis.  (See 
Fig.  182.) 

IRREGULARITIES  PRODUCED  BY  THE  MALPOSITION  OF  LATERALS. 

1.  Mesial  surface  of  lateral  overlapping  distal  surface  of 
central,  while  distal  surface  is  in  a  line  with  cuspid. 


438  ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 

2.  jVEesitil  surface  of  lateral  overlapping  distal  surface  of 
central,  while  distal  surface  is  behind  the  cuspid. 

3.  Mesial  surface  of  lateral  behind  the  distal  surface  of 
the  central,  while  the  distal  surface  is  in  a  line  with  the  cus- 
pid. 

4.  Lateral  in  a  line  anterior  to  that  of  central  and  cuspid. 

5.  Lateral  in  a  line  posterior  to  central  and  cuspid. 

6.  Lateral  at  right  angles  with  the  line  of  the  incisor  and 
cuspid. 

7.  Lateral  wholly  inside  the  arch. 

The  lateral  is  found  more  frequently  out  of  position  than 
any  other  tooth  because  it  is  the  weakest  tooth  in  the  arch 
and  has  the  shortest  root,  and  is  therefore  more  easily  dis- 
placed. 

We  have  seen  that  the  position  of  the  central  incisor  is 
the  combined  result  of  the  relative  strength  of  the  alveolar 
process,  the  force  brought  to  bear  upon  it  by  the  posterior 
column  and  the  cuspid,  and  the  peculiarities  of  occlusion. 
The  lateral,  on  the  other  hand,  depends  for  its  position  on  the 
combined  force  of  central  and  cuspid.  Like  other  teeth,  each 
lateral  depends  upon  the  environments  of  its  own  side  of  the 
arch,  independent  of  the  other.  Besides  its  weakness,  two 
other  conditions  are  productive  of  its  change  of  position — 
(1)  the  shortness  and  conical  shape  of  its  root;  (2)  its 
wedge-shaped  crown.  The  shortness  of  its  root,  together 
with  its  conical  outline,  cause  it  to  be  more  easily  impinged 
upon  by  the  root  of  the  incisor,  which  will  produce  partial  rota- 
tion. The  wedge-shape  of  its  crown  facilitates  rotation. 
The  greater  the  diameter  of  the  cutting-edge  in  proportion 
to  that  of  the  root,  the  greater  the  degree  of  rotation  must 
be  before  the  lateral  finds  a  resting-place.  If  the  diameter 
were  equal  to  the  space  left,  and  there  were  no  impinging  on 
the  root,  there  would  be  no  displacements.  But  when  the 
space  is  not  sufficient  for  the  lateral  and  a  pressure  is  brought 
to  bear  on  one  side  of  either  cutting-edge  or  root,  there  must 
be  a  partial  rotation,  which  is  proportioned  to  the  diameter  of 
the  cutting-edge.  The  wedge-shaped  character  of  the  crown 
assists  in  rotation,  as  the  rounded  angle  of  the  anterior  cusp 


THE    HEAD,    FACE,    JAWS   AND    TEETH 


439 


offers  less  resistance  than  a  line  or  surface.  This  gives  rise 
to  the  commonest  form  of  irregularity  (Nos.  1  and  2;  Figs.  188 
and  184),  in  which  the  mesial  surface  of  the  lateral  overlaps 
the  distal  surface  of  the  central,  while  the  distal  surface  of 
the  lateral  is  either  in  a  line  with  the  cuspid  or  just  back 
of  it. 

3.     In  those  cases  where  the  lateral  is  in  a  line  with  the 
cuspid  (Fig.  185),  but  its  mesial  surface  is  behind  the  central. 


Fijr.  183. 


Fis.  184. 


Fig.  185. 


the  cuspid,  having  a  much  broader  mesial  surface,  affords  a 
firm  abutment  to  the  movement  of  the  lateral,  while  the  mesial 
surface  of  the  latter  easily  glides  over  the  narrow,  rounded 
distal  surface  of  the  central  incisor.  In  this  case  the  relative 
diameter  of  the  upper  and  lower  maxillae  determines  the 
occlusion  and  position  in  a  measure.  If  the  lower  maxilla 
and  the  upper  are  properly  proportioned  the  lower  incisor 
may  strike  in  front  of  the  upper. 


4-iO 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


4  and.  5.  Laterals  not  finding  room  in  the  anterior  col- 
umn are  met  with  in  a  lino  in  front  of  that  formed  by  the 
central  and  cuspid  (Fig.  ISO),  or  behind  it  (Fig.  187).  In  both 
cases  there  is  no  rotation  produced  by  a  one-sided  pressure 
either  upon  the  root  or  cutting- edge.  Whether  the  lateral  is 
found  without  or  within  the  line  depends  upon  the  relative 
diameter  of  the  upper  and  lower  maxillae  and  occlusion.  If 
the  proper  relation  exists  and  the  lower  incisors  strike  wnthin 
the  upper,  the  upper  laterals  will  be  found  outside  the  arch. 


Fig.  186. 


Fig.  ix'i. 

When  the  diameter  of  the  upper  arch  is  greater  than  that  of 
the  lower,  its  laterals  may  be  found  within  the  line  of  the 
centrals  and  cuspids.  In  this  case  the  lower  incisors  must 
either  strike  over  the  upper,  which  occurs  when  there  is  a 
proper  relation  of  diameters  of  upper  and  lower  maxillae,  or 
else  they  may  strike  behind  the  upper  laterals,  which  can 
occur  only  when  the  upper  arch  has  a  greater  diameter  than 
the  lower. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  441 

6.  A  rotation  of  90°,  so  that  the  lateral  is  at  rio^ht  angles 
with  a  line  passing  through  centrals  and  cuspids,  can  occur 
only  when  there  is  no  obstruction  to  the  movement  of  either 
root  or  cutting-edge  and  where  there  is  no  proper  occlusion. 
(Fig.  188.) 

7.  Occasionally  a  lateral  is  found  wholly  inside  of  the 
arch.  The  cause  is  twofold.  Sometimes  the  lateral  is 
erupted  so  tardily  that  the  cuspid  pushes  it  out  of  its  place. 
Then,  again,  even  though  it  is  erupted,  in  due  time  the 
greater  relative  (Fig.  189)  size  and  strength  of  the  cuspid  may 
crowd  it  toward  the  palate. 

IRREGULARITIES   PRODUCED    BY   THE    MALPOSITION    OF   THE 

CUSPIDS. 

The  cuspid  is  the  most  important  tooth  in  the  anterior 
part  of  the  mouth  in  regard  to  durability  and  influence  on 
expression.  It  owes  its  durability  to  the  hardness  of  its  tis- 
sue, slowness  of  its  development  and  simplicity  of  shape. 
The  absence  of  sulci  lays  it  less  open  to  the  inroads  of  caries. 
The  pyramidal  shape  of  its  cusp  gives  it  great  power  of  resist- 
ance. Its  strength  depends  on  these  conditions  and  the  length 
of  its  root,  which  exceeds  that  of  any  other  tooth.  Owing 
to  the  length  of  its  root  its  cusp  may  move  farther  from  its 
normal  axis  without  really  forming  a  greater  angle  with  it. 
It  is  placed  at  the  angle  between  the  anterior  and  posterior 
columns  forming  the  key-stone;  hence  it  is  of  the  greatest 
importance  in  affecting  expression.  The  shape  of  the  crown 
may  vary  from  the  agreeable  rounded  outline  of  beauty  to 
the  prominence  of  the  tusk  of  a  wild  beast.  The  limits  of 
variation  of  form  and  position  thus  being  greater  than  those 
of  any  other  tooth,  it  attracts  more  attention  and  does  more 
to  help  make  or  mar  beauty.  The  deviations  from  its  normal 
position  may  be  due  to  malposition  of  the  germ  or  crowding 
out  of  place.  It  is  difficult  at  times  to  determine  which  of 
these  causes  produces  the  irregularity,  though  generally  it  is 
clear. 

When  no  source  of  pressure  upon  the  erupting  tooth  can 


442  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

be  recognized,  such  as  is  the  case  when  the  cuspid  erupts  in  the 
vault,  it  is  safe  to  assume  the  former. 

In  both  the  decichious  and  permanent  set,  as  compared 
with  other  teeth,  the  cuspids  are  late  in  erupting.  In  both  it 
must  seek  its  way  between  two  teeth  already  erupted;  hence 
its  liability  to  be  forced  out  of  place. 

The  permanent  cuspid  rarely  erupts  before  the  twelfth 
year  after  the  centrals,  laterals  and  bicuspids  are  in  position. 
It  is  crowded,  and  therefore  meets  with  obstacles  in  its  descent. 
Its  crypt  is  placed  above  and  in  front  of  those  of  the  lateral 
and  bicuspid.  As  at  the  age  of  nine  the  roots  of  the  incisors 
and  bicuspids  are  pretty  well  calcified,  the  cuspid  may  be 
materially  hindered  in  its  eruption  by  these  when  there  is  a 
lack  of  space.  Its  conical  root  makes  it  yield  easily  to  press  ■ 
ure,  and  its  cusp  glides  readily  over  the  roots  of  the  adjoin- 
ing teeth.  If  the  relation  between  the  calcification  and 
decalcification  of  the  temporary  teeth  does  not  take  place 
simultaneously  a  new  factor  of  disturbance  arises,  for  by  the 
pressure  of  an  additional  obstacle,  in  the  shape  of  a  remaining 
portion  of  the  root  of  a  deciduous  tooth,  the  cuspid  may  be 
thrown  out  of  its  course,  while  a  too  rapid  absorption  of  a 
deciduous  root  leaves  the  column  of  resistance  ])roken,  thus 
opening  a  new  channel  for  the  erupting  tooth. 

The  position  of  its  crypt  above  and  in  front  of  those  of 
the  lateral  and  bicuspid  accounts  for  the  most  common  form 
of  irregularity,  i.  e. ,  being  outside  of  the  arch  and  above  the 
other  teeth.  The  tendency  of  the  cusp  is  necessarily  forward, 
because  the  combined  force  of  the  bicuspids  and  the  first  per- 
manent molar  from  behind  is  greater  than  that  of  the  lateral 
in  front;  hence  the  lateral  is  easily  pushed  out  of  place. 
Besides,  the  roots  of  all  teeth  naturally  pointing  backward 
would  give  it  this  tendency. 

'When  in  its  normal  position  the  cuspid  pushes  its  way 
between  the  roots  of  the  lateral  and  bicuspid,  and  thereby 
spreads  the  arch,  giving  it  a  parabolic  outline  and  forming 
a  key-stone;  but  when  it  remains  outside  of  the  arch,  the 
expanded  contour  is  lost  and  a  pinched  condition  results  in 
the  shape  of  a  V-shaped  arch.    The  additional  pressure  of  the 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


443 


cuspid  upon  the  region  of  the  lateral  only  increases  this  ten- 
dency. The  cuspid  when  out  of  place  is  usually  found  above 
and  outside  of  the  lateral  and  bicuspid,  this  tendency  being 
given  by  the  position  of  its  germ  and  its  calcification  being 
late  as  compared  with  other  teeth.     (Fig.  190.) 

One  or  two  cuspids  may  be  found  erupted  in  the  palatal 
vault  when  there  is  a  malposition  of  the  germs.     (Fig.  191.) 


Fig.  190. 


Fig.  191. 


Fig.  192. 

Occasionally  it  is  found  outside  of  the  first  bicuspid  or  between 
the  first  and  second  bicuspid,  sometimes  in  front  or  anterior 
to  the  lateral.  (Figs.  192  and  193.)  Frequently  it  takes  the 
place  of  the  lateral.  (Fig.  194.)  Sometimes  one  cuspid  is 
found  in  the  palate  while  the  other  is  on  a  line  pointing  inward. 
(Fig.  195.)  When  it  comes  through  in  this  position  the  decid- 
uous cuspid  may  still  be  in  position,  the  first  bicuspid  having 


U-i 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


crowded  forward  to  the  lateral.  (Fig.  196.)  Occasionally 
when  the  cuspid  is  missing,  the  lateral  will  drop  backward. 
(Fig.  197.)  Its  usual  position  when  in  the  palate  is  inside  the 
lateral  incisor,  but  sometimes  it  is  embedded  in  the  hard  pal- 


t'ig.  194. 


Fig.  195. 


ate.  A  pinched  condition  in  the  bicuspid  region  necessarily 
results  from  such  malposition,  owing  in  part  to  the  want  of 
prominence  of  this  tooth  when  in  its  normal  position  and  in 
part  to  the  inward  pressure  of  the  cuspid  upon  the  bone-cells. 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


445 


(Figs.  198  and  199.)  When  the  cuspid  moves  out  of  position 
it  does  so  at  the  expense  of  the  first  bicuspid  and  lateral 
incisor.  The  force  may  be  so  great  as  to  push  the  lateral  for- 
ward and  through  the  alveolar  process.  When  the  cuspid  is 
found  in  the  roof  of  the  mouth,  or  out  of  its  normal  position, 
the  posterior  column  moves  forward,  filling  the  space  usu- 
ally occupied  by  the  cuspid  (Fig.  194),  and  the  half  of  the  arch 
of  which  this  tooth  is  a  member  remains  undeveloped.     (Fig. 


Fis.  197. 


Fig.  198. 


Fig.  199. 


198.)  If  the  cuspids  erupt  simultaneously  the  pressure  exerted 
is  uniform,  and  there  is  less  liability  to  irregularity.  One  may 
erupt  normally  while  the  other  may  be  abnormal  in  position. 

IRREGULARITIES    PRODUCED    BY   THE    MALPOSITION   OF 
BICUSPIDS. 

The  shape  of  the  crown  of  the  bicuspid  particularly  endan- 
gers it  to  irregularities  of  position.  The  antero-posterior 
diameter  of  its  outer  cusp  is  greater  in  proportion  than  that 
of  the  inner,  having  a  wedge-shaped  space  on  the  palatal  side. 


446 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 


This  causes  it  to  touch  at  one  point  the  tooth  in  front  and  back 
of  it,  and  makes  rotation  upon  its  axis  easy.  Irregularities 
are  chiefly  limited  to  the  second  bicuspid  for  reasons  that 
become  apparent  when  we  consider  their  causes. 

Like  irregularities  of  other  teeth,  irregularities  of  bicus- 


Fig.  200. 


Fig,  201. 


pids  may  arise  from  constitutional  causes,  i.  e.,  from  a  lack 
of  accord  between  the  size  of  the  jaw  and  that  of  the  teeth,  or 
from  local  causes.  The  latter  are  frequent  and  come  under 
the  following  heads:  (1)  Tardy  eruption;  (2)  deflection  due  to 
the  retention  of  temporary  roots;  (3)  forward  movement  of 
the  molars  and  (4)  rotation  from  want  of  occlusion. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  447 

1.  Tardy  eruption. — The  natural  order  of  eruption  is:  first 
bicuspid;  second  bicuspid;  cuspid.  But  this  is  disturbed 
occasionally,  so  that  the  first  bicuspid  is  followed  by  the  cus- 
pid, thus  pushing  it  backward.  When  there  is  a  lack  of  space 
the  second  bicuspid  must  seek  its  way  between  the  first  bicus- 
pid and  the  first  permanent  molar,  and  if  there  is  a  lack  of 
room  it  is  crowded  outside  or  within  the  arch.     (Fig.  200.) 

2.  Deflection. — When  a  temporary  molar  is  retained  too 
long,  or  its  root  is  not  absorbed  as  fast  as  the  bicuspid  is 
erupted,  this  obstacle  may  deflect  the  bicuspid  or  cause  it  to 
rotate  more  or  less  upon  its  axis,  being  favored  by  the  spongy 
character  of  the  alveolar  process.     (Fig.  201.) 

3.  The  forward  movement  of  the  molars  necessarily  dimin- 
ishes the  space  left  for  bicuspids  and  cuspids,  and  when  the 
first  bicuspid  and  cuspid  erupt  before  the  second  bicuspid, 
this  may  be  crowded  out  of  its  proper  place. 

4.  A  rotation  of  a  bicuspid  from  a  want  of  proper  occlusion 
is  not  rare.  An  examination  of  the  grinding  surface  of  the 
bicuspid  shows  that  it  is  designed  to  articulate  with  an  oppos- 
ing tooth.  When  its  two  cusps  fail  to  find  an  opposing  cusp 
to  keep  them  in  place  its  function  is  lost  and  its  fixedness  of 
position  endangered. 

Frequently  more  than  one  of  these  causes  are  at  work,  or 
one  implies  another.  Thus,  if  there  is  accord  between  the  size 
of  the  jaw  and  that  of  the  teeth,  some  of  the  local  causes  can- 
not arise;  the  cuspid  may  erupt  before  the  second  bicuspid 
without  disarranging  the  arch,  and  a  bicuspid  may  be  deflected 
by  a  deciduous  root  and  ultimately  move  into  place  unless 
crowded  upon  by  a  six-year  molar.  Rotation  may  be  the  refeult 
of  a  crowded  condition,  throwing  the  tooth  out  of  the  arch 
when  proper  occlusion  is  out  of  the  question. 

As  the  first  bicuspid  erupts  before  the  second,  it  has  all 
the  advantage  of  such  space  as  there  is.  It  may  be  crowded 
out  of  place  by  the  forward  movement  of  the  six-year  molar 
together  with  the  premature  eruption  of  the  cuspid.  Perma- 
nent deflection  due  to  the  retention  of  a  deciduous  root  is  out 
of  the  question  when  there  is  sufficient  space,  but  rotation 


4JrS  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

upon  its  axis  from  want  of  proper  occlusion  may  occur  here 
as  elsewhere. 

The  posterior  surface  of  the  bicuspid  touches  the  first  cus- 
pid only  at  one  point,  being  an  angle  and  not  a  surface,  and 
this  is  a  fruitful  source  of  irregularity. 

IRREGULARITIES  OF  THE  TEETH  PRODUCED  BY  THf:  EXTRACTION 
OF  THE  FIRST  PERMANENT  MOLAR. 

Irregularities  first  attracted  attention  by  the  deformity 
they  produced,  not  by  their  interference  with  function. 
Overcrowded  anterior  portions  of  the  arch  and  displacement 
of  individual  teeth  were  noticed.  A  long  time  elapsed  before 
the  results  of  injudicious  extraction  were  observed.  There- 
fore the  first  permanent  molar  was  ruthlessly  destroyed  until 
comparatively  recent  times,  producing  a  large  proportion  of 
irregularities  in  the  form  of  malocclusion.  This  loss  of  func- 
tion is  produced  so  gradually  that  the  patient  is  not  aware  of 
it;  he  may  notice  inconvenience  in  mastication,  but  does  not 
attribute  it  to  the  cause,  as  even  persons  of  great  intelligence 
know  little  about  the  occlusion  of  their  teeth. 

This  tooth  has  been  hitherto  sacrificed  for  two  reasons : 
(1)  Its  early  decay,  brought  about  by  the  tax  upon  the  sys- 
tem of  the  growing  child  and  the  neglect  from  which  the 
teeth  sufi"er,  particular!}^  during  the  period  of  its  develop- 
ment. The  parent  usually  does  not  know  of  its  existence 
until  the  child  complains  of  toothache.  (2)  The  tooth  has  been 
extracted  to  correct  an  overcrowded  arch. 

When  removed  to  stop  pain,  the  pain  is  indeed  relieved 
by  extraction,  but  has  in  its  train  many  evils  hereafter  pointed 
out.  When  removed  to  correct  a  crowded  arch,  twice  as 
much  space  is  gained  as  desirable,  and  the  crowded  arch  is 
not  relieved,  as  the  cuspid,  because  of  the  length  and  strength 
of  its  root,  remains  stationary,  while  the  bicuspids  move  back 
singly  or  in  pairs,  leaving  the  position  of  the  incisors 
unchanged.  The  disastrous  eflects  of  extracting  the  first 
molar  become  apparent  when  its  function  is  understood.  We 
cannot  do  better  than  give  its  fourfold  function,  as  stated  by 


THE    HEAD,    FACE,    JAWS   AND   TEETH  449 

Dr.  J.  E.  Cravens,  of  Indianapolis,  in  the  annual  of  Univer- 
sal Medical  Science  of  1888: 

"The  first  permanent  molar  has  four  distinct  functions: 

(1)  To  supply  additional  surface  for  mastication  when  devel- 
opment has  progressed  so  that  the  deciduous  molars,  unaided, 
are  no  longer  competent  to  meet  the  requirements  of  nature. 

(2)  To  support  the  crowns  of  the  deciduous  molars  when  they 
have  become  unstable,  because  of  absorption  of  their  roots 
to  accommodate  the  advance  of  their  immediate  successors — 
the  bicuspids — which  are  usually  erupted  between  the  ninth 
and  the  eleventh  years.  The  deciduous  molars  begin  to 
loosen  six  to  twelve  months  before  their  final  displacement. 
Should  a  permanent  first  molar  be  extracted  early — say 
between  the  seventh  and  eighth  years — the  deciduous  molars 
supported  by  it  would  loosen  prematurely  so  as  to  be  unserv- 
iceable for  mastication,  and  perhaps  be  lost  six  to  twelve 
months  before  the  eruption  of  the  succeeding  bicuspids.  (3) 
To  guide  the  second  bicuspid  into  position  in  event  of  a  loss 
of  this  molar  previous  to  eruption  of  the  second  bicuspid,  the 
latter  is  liable  to  erupt  back  of  its  true  position,  or  after 
erupting  nominally  to  float  backward  along  the  ridge  of  the 
gum,  inclining  posteriorly,  in  such  a  manner  as  seriously  to 
impair  its  effectiveness  as  a  masticating  organ.  This  is  par- 
ticularly the  case  in  the  inferior  maxilla.  (4)  To  induce 
additional  development  of  the  horizontal  portion  of  the  lower 
jaw,  immediately  anterior  to  the  ramus,  in  order  to  make 
easier  the  eruption  of  the  permanent  second  molar,  and  to 
prevent  the  well-known  tendency  of  the  latter  to  tip  forward, 
thus  weakening  the  support  of  its  roots  and  impairing  its 
value  as  a  grinder. 

' '  The  first  permanent  molar  is  supposed  by  many  observ- 
ers to  exercise  an  important  influence  in  establishing  a  proper 
angle  to  the  inferior  maxilla.  If  such  idea  is  correct  (and 
several  conditions  indicate  that  it  is),  it  adds  possibly  another 
to  the  already  long  and  important  list  of  the  functions  per- 
taining to  this  tooth." 

The  wholesale  extraction  of  the  first  permanent  molar  in 
the  past  has,  no  doubt,  caused  arrest  of  development  of  the 


450  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

alveolar  process  as  well  as  of  the  maxillary  bones,  for  the 
process  and  jaws  depend  for  their  development  largely  on  the 
function  of  the  teeth,  their  articulation  and  their  motion 
stimulating  nutrition  and  enlarging  the  arch. 

Some  of  the  older  dentists,  whose  skill  is  the  result  of 
routine  rather  than  knowledge,  are  still  to  be  found  extracting 
four  sound  molars  Avithout  the  least  thought  of  the  conse- 
quences. Such  a  one,  who  was  practicing  in  a  southern  par- 
ish not  many  years  ago,  was  in  the  habit  of  taking  out  the 
first  permanent  molar  in  every  instance.  He  said  the  result 
was  "  that  all  the  people  in  that  part  of  the  country  possessed 
good,  regular  teeth,  and  that  an  irregularity  was  the  excep- 
tion.'' The  author  has  observed  in  many  cases  the  want  of 
development  of  the  alveolar  process,  and  sometimes  the  jaws, 
from  the  extraction  of  those  teeth.  This  assertion  is  verified 
in  those  cases  where  the  germ  has  not  developed  and  the  tooth 
is  missing.  More  marked  instances  are  those  where  three 
or  four  germs  are  wanting.  The  loss  of  a  tooth  performing 
such  a  work  as  the  first  permanent  molar  impairs  mastication 
and  produces  vicious  occlusion,  and  is  detrimental  to  the  con- 
tour of  the  face.  When  extracted  before  the  second  molar  is 
erupted,  one-half  or  more  of  the  grinding  surface  of  the  teeth 
is  lost. 

The  nutrition  of  the  patient  suflfers  in  proportion,  and 
health  may  be  seriously  impaired  because  of  inability  to  mas- 
ticate food  properly. 

The  horizontal  portion  of  the  lower  jaw  will  be  but  imper- 
fectly developed,  because  function,  one  of  the  most  important 
means  of  development,  is  lost  and  insutficient  room  is  left  for 
the  second  and  third  molars. 

When  a  jaw  with  deciduous  teeth  is  compared  with  one 
having  permanent  teeth,  we  notice  a  difference  in  the  length 
of  the  rami  and  bodies,  and  a  still  greater  difference  in  the 
anglei^.  This  difierence  results  from  the  gradual  separation 
near  the  angle,  and  is  due  to  the  growth  of  the  molars.  The 
arches  of  the  permanent  set  are  separated  posteriorly  by  the 
eruption  of  the  first  permanent  molar.  When  these  molars 
are  lost  before  the  second  molars  are  in  place,  the  character- 


THE    HEAD,    FACE,    JAWS    AND   TEETH  451 

istic  angle  of  the  jaw  becomes  less  marked.  The  loss  of  this 
molar  on  one  side  only  will  produce  asymmetry  of  the  two 
sides  of  the  face,  noticeable  perhaps  only  to  the  trained  eye, 
the  parallelism  of  the  two  arches  having  been  disturbed.  If 
the  two  are  lost  early,  the  jaws  approach  each  other  more 
than  normally  near  the  angle,  throwing  the  force  of  mastication 
forward.  As  the  first  and  second  bicuspids  do  not  erupt  until 
the  tenth  or  eleventh  year,  and  the  deciduous  molars  loosen 
six  to  twelve  months  before  they  are  displaced,  the  child  is 
forced  to  masticate  its  food  for  several  years  on  a  portion  of 
the  arch  designed  for  other  purposes,  compelling  these  teeth 
to  perform  the  unnatural  function  of  grinding.  This  confu- 
sion of  functions  produces  but  imperfect  results  and  changes 
the  outline  of  the  face. 

As  the  first  permanent  molar  erupts  it  acts  as  a  fixed 
point,  separating  and  holding  the  jaws  somewhat  throughout 
their  entire  extent,  in  front  as  well,  so  as  to  make  room  for 
the  growing  incisors.  The  deciduous  incisors,  being  very 
much  shorter  than  the  permanent  ones,  necessarily  have  a 
shorter  bite.  ,  When  the  first  permanent  molar  is  lost  the 
natural  bite  is  shortened,  for  this  molar  acts  as  a  force  which 
lengthens  the  arches  backward  and  also  separates  them  ver- 
tically. 

When  this  tooth  is  lost  the  lower  permanent  incisors  as 
they  develop  strike  with  greater  force  against  the  upper  and 
are  carried  forward.  The  change  at  first  is  imperceptible, 
but  in  the  course  of  time  these  teeth  will  be  found  spreading 
more  or  less  like  a  fan.  Though  the  organic  relation  of  the 
upper  and  lower  jaw  is  not  so  apparent  at  first  as  that  of  other 
organs,  and  the  two  jaws  seem  to  enjoy  greater  independ- 
ence, proper  occlusion  is  indispensable  to  their  health,  and 
the  teeth  in  the  lower  arch  are  forced  out  of  their  sockets  by 
a  deposit  of  osseous  material  not  consumed  through  proper 
function. 

Naturally  bicuspids  tend  to  move  forward  because  of  the 
inclination  of  the  root  and  the  angle  formed  by  the  two  jaws, 
which  makes  the  teeth  strike  at  an  angle  as  well.  This  ten- 
dency usually  prevents  them  from  moving  back,  even  if  the 


452  ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


lllffllllllll^^ 

Fig.  202. 


Fig.  203. 


Fig.  204. 


THE    HEAD,    FACE,    JAWS    AND   TEETH  453 

first  molar  is  extracted.  When  the  cusps  are  long  they  usually 
retain  their  natural  articulation,  but  sometimes,  as  has  been 
pointed  out,  they  move  backward.  They  may  move  back 
separately  or  may  drop  back  together.  (Fig.  202.)  This 
dropping  back  destroys  the  articulation,  causing  the  oppos- 
ing teeth  to  strike  only  at  certain  points  instead  of  bringing 
surfaces  in  contact,  and  frequently  partial  rotation  upon  their 
axes  results. 

The  most  ordinary  result  of  the  extraction  of  this  tooth  is 
the  forward  movement  of  the  second  and  third  molars  (Fig. 
203),  causing  these  to  tip  forward  and  resulting  in  vicious 
articulation,  as  shown  by  Dr.  Davenport  in  the  Dental  CosmoB 
of  July,  188T.  Externally  the  articulation  may  appear  not 
to  have  suffered,  but  when  it  is  examined  inside  of  the  arch, 
it  is  found  that  the  opposing  teeth  meet  only  at  certain  points, 
becoming  thereby  partially  useless.  Fig.  204  shows  the  for- 
ward movement  of  the  first  permanent  molar.  The  tempo- 
rary molars  on  right  side  are  in  place,  thus  holding  the  first 
permanent  molar  in  place;  while  on  the  left  side  the  tempo- 
rary molars  have  been  extracted  and  the  first  molar  has  moved 
forward  one-fourth  inch.  The  force  of  mastication  and  the 
direction  of  the  roots,  together  with  the  eruption  of  the  second 
molar,  increases  this  tendency. 

Length  of  the  rami,  body,  depth  of  sulci  of  the  masticat- 
ing surface  and  local  peculiarities  of  the  teeth  in  front,  may 
so  modify  the  occlusion  as  to  result  in  bilateral  asymmetry, 
and  the  degree  of  tipping  forward  may  be  quite  unlike. 


CHAPTER  XXXIV. 

LOCAL    CAUSES    OF    IRREGULARITIES    OF    THE 
TEETH— LOWER  JAW. 

The  upper  and  the  lower  jaw  are  quite  distinct  in  char- 
acter, function  and  course  of  development,  however  similar 
they  may  appear  to  be. 

The  upper  when  normal  describes  a  portion  of  a  lar<^er 
circle,  the  teeth  overlapping  those  of  the  lower.  It  is  fixed, 
and  depends  for  its  function  entirely  on  the  activity  of  the 
lower.  Owing  to  this  immobility,  when  irregularities  exist 
they  are  of  a  more  marked  constitutional  type.  Thus  we 
have  the  various  abnormal  arches  not  seen  in  the  lower;  the 
high  and  narrow  vault  and  the  inward  curvature  of  alveolar 
processes.  It  has  a  greater  sweep  of  development,  and  con- 
sequently greater  possibility  of  irregularity  in  its  anterior 
columns,  because  these  are  unrestricted;  while  the  lower  is 
restrained  by  the  overlapping  of  the  upper  teeth.  The  lower 
jaw  is  hung  loosely,  but  firmly  by  its  condyles,  permitting 
motion  in  three  directions — antero-posterior,  vertical,  and 
lateral. 

In  Fig.  205  the  six  anterior  inferior  incisors  are  shown. 
Observe  that  the  points  of  contact  are  at  their  cutting  edges, 
the  mesial  and  distal  surfaces  being  rounded,  which  enables 
them  to  crowd  easily  past  each  other  when  force  is  applied; 
the  roots  are  flattened  at  their  sides,  so  that  when  pressure 
is  brought  to  bear  upon  them  they  move  with  readiness  over 
a  considerable  distance.  That  the  pressure  cannot  well  be 
exerted  in  a  straight  line  through  the  posterior  column,  and 
from  thence  extend  in  a  curve  through  the  anterior  teeth, 
appears  from  the  law  of  simple  forces,  which  act  in  straight 
lines  only.  The  cuspid,  finding  no  resistance  in  front,  but 
being  resisted  by  the  incisors  slightly  at  the  side,  must  neces- 
sarily  pass  forward.  The  lateral  is  too  weak  to  afford  resist- 
ance. Even  if  the  centrals  could  be  acted  upon  by  the 
pressure  from  behind,  they  could  be  prevented  from  assuming 

454 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


455 


aV-shape  by  the  overlapping  incisors  above;  for  the  more 
the  upper  arch  is  compressed  laterally,  and  the  mesial  angle 
of  the  central  is  turned  outward,  the  more  will  the  distal  angle 
be  turned  inward,  and  thus  confine  the  lower  incisors. 

The  lower  incisors  being  narrower  than  the  upper  only 
favors  this  tendency.  These  conditions  are  necessarily  mod- 
ified by  the  local  peculiarities  of  the  upper  arch,  the  relative 
strength  of  the  teeth  and  the  nature  of  the  occlusion  being 
all-important  factors  in  determining  final  results. 

Fig.  206  is  a  diagram  of  a  normal  lower  maxilla.  The  line 
a  h  passes  through  the  cuspids,  bicuspids  and  molars,  and 
shows  the  direction  of  the  force  exerted  by  the  posterior  col- 


umn upon  the  anterior.  For  its  growth  it  depends  far  more 
upon  function  than  the  upper.  The  growth  of  the  lower  jaw 
is  limited  to  the  posterior  column,  as  has  been  mentioned, 
this  being  accomplished  by  the  absorption  of  the  anterior 
border  of  the  rami,  while  bone-cells  are  deposited  along  its 
posterior  border.  Its  freedom  of  motion  is,  however,  retarded 
by  the  arch  of  the  upper  maxilla,  for  which  reason  irregular- 
ities are  much  rarer  in  the  lower  than  the  upper  jaw,  as  the 
overlapping  of  the  upper  teeth  tends  to  correct  any  predispo- 
sition to  malarrangement. 

Irregularities  of  this  jaw  result  more  from  local  causes  than 
those  of  the  upper  maxilla,  except  those  found  in  the  under- 
hung jaw.  Its  development  depends  largely  on  mastication. 
Owing  to  its  movements  there  are  fewer  irregularities  in  this 
maxilla  and  the  jaw  is  more  apt  to  be  normal.     Irregularities 


456  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

back  of  the  cuspid  are  veiy  rare.  Occasional  contractions  of 
the  lower  arch  occur,  such  as  dipping  in,  which  is  due  to 
peculiarities  of  occlusion.  When  cases  of  irregularity  exist 
they  are  generally  found  in  mouths  the  lower  arch  of  which 
exceeds  the  upper  in  diameter,  thus  permitting  less  firm 
interlocking  and  greater  freedom  of  individual  teeth. 

When  the  diameter  of  the  circle  of  the  teeth  of  the  lower 
jaw  exceeds  that  of  the  upper,  its  lateral  movement  causes  an 
enlargement  of  the  upper  circle  by  opening  the  median 
suture,  this  condition  being  indicated  by  the  spreading  of  the 
superior  central  incisors.  As  has  been  shown  in  the  chapter 
on  migration  of  teeth,  twisted  bicuspids  often  result  from 
entire  want  of  occlusion  or  the  touching  of  two  opposing 
teeth  at  only  one  point.  The  most  frequent  form  of  irregu- 
larity is  a  crowding  of  the  incisors.  This  is  generally  the 
case  where  the  size  of  the  teeth  and  the  jaw  are  not  in  har- 
mony, and  is  due  to  two  causes:  (1)  The  teeth  of  the  lower 
jaw  are  forced  inward  by  occlusion,  the  diameter  of  the  circle 
of  the  upper  teeth  being  usually  the  smaller;  (2)  The  forward 
movement  of  the  posterior  column. 

The  two  halves  of  the  lower  arch,  like  those  of  the  upper, 
for  obvious  reasons  do  not  present  the  same  forms  of  irregu- 
larity. Like  the  upper  jaw,  the  lower  is  subject  to  forward 
movement  of  the  posterior  column.  A  want  of  harmony  in 
the  development  of  upper  and  lower  maxillse  produces  a 
crowded  condition  of  the  lower  arch,  resulting  in  pressure 
upon  the  anterior  column. 

The  direction  of  the  roots  of  the  lower  molars  greatly 
increases  this  tendency.  When  the  crowns  of  the  second  and 
third  molars  are  erupted  the  first  molar  is  pushed  forward. 
The  pressure  is  exerted  principally  through  the  posterior  col- 
umn upon  the  cuspid,  and  is  in  a  straight  line.  This  tooth, 
by  virtue  of  its  rounded  cusp,  slips  by  the  lateral  and  is  pro- 
jected forward  often  beyond  the  central  incisors,  leaving  the 
lateral  behind. 

Like  the  upper  maxillae  the  two  halves  of  the  alveolar 
arch  are  separate,  and  are  modified  independently.  An  irreg- 
ularit}'  on  one  side  by  no  means  indicates  a  similar  irregular- 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


45Y 


ity  on  the  other,  owing  to  the  difference  of  pressure  that  may 
be  "exerted. 

Fig.  207  shows  the  left  dental  arch  normal,  but  the  for- 
ward movement  of  the  posterior  column  has  caused  the  right 


Fiff.  206. 


Fiu'.   207. 


Fig.  208. 


Fig.  209. 


Fig.  210. 


lateral  to  fall  behind.  As  the  two  columns  converge  anteri- 
orly they  exert  their  pressure  in  this  direction,  in  consequence 
of  which  we  find  irregularities  of  the  lower  jaw  confined  for 
the  most  part  to  the  region  of  the  incisors. 


458  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

Though,  as  stated  before,  the  laterals  are  generally  pressed 
within,  while  the  centrals  occupy  their  usual  position,  these 
teeth  may  stand  at  various  angles,  which  are  determined  by 
the  local  peculiarities  of  the  teeth  of  the  upper  maxilla.  Thus 
it  may  happen  that  a  cuspid  or  a  lateral  may  strike  outside  of 
its  antagonist  of  the  opposite  jaw. 

Fig.  208  illustrates  a  common  form  of  irregularity,  in 
which  both  posterior  columns  have  moved  forward.  The  lat- 
evah  are  crowded  backward  and  inward.  The  lines  of  force 
are  also  directed  inward,  but  a  V-shaped  arch  is  prevented  by 
the  lower  centrals  striking  against  the  palatal  surfaces  of  the 
upper  centrals.  If  the  cause  of  this  form  of  irregularity  is 
borne  in  mind  it  will  be  understood  why  the  extraction  of  a 
lower  lateral  or  central  makes  this  form  of  irregularity  still 
worse,  inasmuch  as  it  disarranges  the  occlusion  of  the  cuspids. 

In  Fisf.  209  we  see  the  right  dental  arch  normal.  The 
left  posterior  column  has  pushed  against  the  lateral,  and 
meeting  with  suJfficient  resistance,  the  central  is  carried  back- 
w^ard.  While  erupting,  the  central  was  carried  inward, 
owing  to  a  want  of  harmony  of  development.  Two  centrals 
have  been  found  directed  inward,  though  this  form  of  irreg- 
ularity is  rare. 

Fig.  210  shows  the  left  dental  arch  normal.  The  forward 
movement  of  the  posterior  column  on  the  right  side  has 
caused  the  cuspid  to  advance  beyond  the  line  of  the  incisors. 
The  rotation  of  the  cuspid  upon  its  axis  caused  it  to  pass  by 
the  lateral,  leaving  it  in  position.  This  is  a  common  form  of 
irregularity.  Occasionally  the  cuspid  is  carried  forward  in 
the  direction  of  the  pressure.  Such  a  case  is  illustrated  in 
Fig.  211.  The  left  lateral  has  been  carried  inward  in  the 
manner  already  described.  The  posterior  column  has  pushed 
the  cuspid  on  the  right  side  laterally  so  that  it  occupies  the 
position  of  the  right  lateral,  and  the  bicuspid  is  carried  for- 
ward and  outside  of  the  arch. 

THE  INFERIOR  CUSPID. 

The  cuspid  erupts  in  line  with  the  other   anterior  teeth 
unlike  the  upper,  the  crypt  of  which  is  above  and  outside  of 


THE    HEAD,    FACE,    JAWS   AND   TEETH 


459 


the  lateral  incisor  and  bicuspids.  For  this  reason  and  the 
fact  that  the  upper  cuspid  tends  to  keep  it  in  position  by 
occlusion,  irregularities  of  the  cuspid  of  the  lower  jaw  are  not 
so  common  as  those  of  the  upper.  When  the  tooth  is  found 
out  of  line,  it  is  anterior  of  its  normal  position, — rarely,  if 
ever,  posterior.  Its  eruption  may  be  tardy,  giving  the 
advantage  of  time  to  the  upper  cuspid  and  directing  the  lower 
cuspid  outward.     In  a  crowded  jaw  a  disarrangement  of  the 


Fig.  211. 


Fig.  212. 

incisors  may  follow,  leaving  the  lateral  almost  directly  behind 
the  cuspid,  as  in  Fig.  211.  When  there  is  a  malposition  of 
the  cuspid  on  one  side  of  the  maxilla,  the  cuspid  of  the  oppo- 
site is  usually  pushed  forward,  as  seen  in  the  same  illustra- 
tion. 

Owing  to  a  malposition  of  the  germ,  the  cuspid  may  be 
found  outside  of  the  incisors  in  the  median  line  (Fig.  212),  or 
even  inside  of  the  arch  (Fig.  213).  Karely  it  is  found  on 
the  median  line  between  the  incisors,  as  shown  in  this  illus- 
tration. 


460 


ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 
LOWER  BICUSPIDS. 


Like  the  cuspid,'  the  position  of  the  bicuspid  is  most  fre- 
quently affected  by  the  forward  movement  of  the  posterior 
columns.  An  irregularity  in  a  lateral  direction  is  rare,  since 
the  density  of  the  lower  maxilla  is  unfavorable  to  this. 

Whenever  a  bicuspid  is  found  without  or  within  the  arch, 
it  is  due    to   the  undue  retention  of  the   temporary  teeth. 


Fig.  213. 


Fig.  214. 


Fig.  215. 


Fig.  214  shows  the  second  bicuspid  situated  inside  the  arch, 
while  Fig.  215  shows  the  first  bicuspid  inside  and  the  second 
bicuspid  outside  of  the  arch.  Twisted  bicuspids  occur  fre- 
quently from  a  want  of  proper  occlusion,  when  the  space 
yielded  by  the  lower  jaw  is  larger  than  that  of  the  upper, 
or  when  the  fi*rst  molar  is  extracted. 

When  the  second  temporary  molar  is  retained  too  long, 
the  first  permanent  molar  may  be  pushed  forward,  thus  con- 
fining the  bicuspid  and  preventing  it  from  erupting. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  461 

MIGRATION   OF   TEETH. 

That  teeth  move  when  acted  upon  by  some  external  force 
is  known  to  every  practitioner,  and  is  utilized  in  his  opera- 
tions by  producing  temporary  separations,  in  regulating  and 
the  like.  Why  they  should  move  from  their  normal  position 
without  any  apparent  cause  is  not  so  easy  to  explain,  and 
theories  have  been  recently  advanced  to  account  for  this.  It 
is  obvious  that  when  the  arch  of  the  alveolar  process  is  greater 
than  that  of  the  combined  diameters  of  the  teeth,  there  must 
be  a  space  or  spaces  somewhere.  This  space  is  usually  equally 
distributed  among  the  anterior  teeth.  Sometimes,  however, 
spaces  are  found  that  disfigure  the  mouth,  and  besides  these 
we  find  occasionally  one  or  more  teeth  that  appear  to  have 
rotated  upon  their  axes.  An  inquiry  into  these  forms  of 
motion  is  the  province  of  this  chapter. 

This  subject  is  best  considered  under  two  heads:  (A)  Per- 
fect occlusion ;  (B)  proper  relation  between  waste  and  repairs. 

(A)  If  the  occlusion  of  the  teeth  is  perfect,  so  that  each 
tooth  is  kept  in  place  by  its  adjoining  neighbors  and  the 
opposing  tooth,  dislodgment  is  impossible.  All  teeth  should 
touch  those  adjoining  them  at  the  extremities  of  their  greatest 
diameter.     This  allows  a  slight  lateral  motion. 

Good  occlusion  differs  according  to  the  function  of  dif- 
ferent teeth.  Their  shapes  indicate  this.  The  upper  and  lower 
incisors  overlap  each  other,  producing  what  is  termed  the 
overbite.  In  the  normal  relation  they  strike  in  a  straight  line, 
which  passes  through  their  roots.  The  curved  lingual  sur- 
face of  the  upper  incisors  allows  for  their  sliding  into  this 
position.  The  force  being  thus  exerted  in  straight  lines, 
there  is  a  constant  tendency  to  keep  them  in  position,  and  as 
the  pressure  upward  and  downward  is  vertical,  spreading  of 
the  upper  incisors  is  impossible.  The  relation  of  cuspids  is 
similar.  Quite  otherwise  with  bicuspids  and  molars.  Begin- 
ning with  the  bicuspids,  we  find  the  cusps  of  the  first  superior 
bicuspid  striking  not  over  that  of  the  first  lower  bicuspid 
alone,  but  over  the  angles  formed  by  the  distal  side  of  the 
first  lower  and  mesial  side  of  the  second.     Each  tooth  begin- 


462 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 


ning  at  this  point  is  not  only  in  relation  to  one  below,  but  to 
two,  and  when  one  of  these  teeth  is  extracted  the  order  of 
the  mouth  is  disturbed^,  and  a  rearrangement  of  some  kind 
usually  follows.  What  this  will  be  de[)ends  on  a  variety  ot 
circumstances. 

A  typical  example  is  furnished  by  the  extraction  of  the 
first  molar.  Every  practitioner  has  observed  the  forward 
movement  of  the  second  molar  as  a  consequence.  A  tilting 
forward  of  this  tooth  results.  The  reason  for  this  is  obvious 
when  we  remember  that  the  posterior  cusp  of  the  first  upper 
molar  strikes  the  anterior  cusp  of  the  second  lower  and  exerts 


Fig.  4(30. 

its  whole  force,  which  was  meant  to  be  distributed  on  both 
cusps,  on  it. 

(B)  The  position  of  the  teethis  not  determined  alone  by 
the  relative  size  of  the  maxillas  and  the  occlusion  of  the  teeth. 
Nutrition  and  absorption,  waste  and  repair,  play  an  important 
part.  On  the  perfect  harmony  of  these  the  beauty  and  health 
of  the  teeth  depend.  Changes  in  the  position  and  removal  of 
bone-cells  go  on  constantly  and  vary  with  the  age  and  other 
physical  conditions  of  the  patient.  This  disposition  and 
removal  of  bone-cells  is  seen  in  the  changes  that  the  lower 
maxillae  undergo  during  different  periods  of  life.  When  the 
deciduous  teeth  are  replaced  by  the  permanent  ones,  the  arch 
of  the  jaw  becomes  more  pronounced,  and  there  is  a  lengthen- 
•'ng  of   the   alveolar  ridge   backward   to   accommodate  the 


THE    HEAD,    FACE,    JAWS    AND   TEETH  463 

molars.  When  the  senile  chcanges  take  place  the  angle  of  the 
jaw  becomes  more  obtuse.  That  there  is  a  similar  adjust- 
ment to  circumstances  going  on  constantly  is  proven 'by  cir- 
cumstances. Correction  of  irregularities  depends  on  this. 
The  position  of  the  teeth  in  the  alveoli  is  determined  solely 
by  the  tissues  around  it.  By  producing  a  pressure  in  a  given 
direction,  bone-cells  may  be  removed  on  one  side  and  others 
deposited  on  the  other  and  the  position  of  the  tooth  changed. 
The  change  in  the  deposit  and  removal  of  osseous  matter  is 
not  unlike  that  of  the  deposit  of  particles  of  earth  in  the  bed 
of  a  river  where  stakes  have  been  placed  for  the  purpose  of 
locating  the  bed  of  the  river.  By  the  successive  deposit  and 
removal  of  these  particles  the  position  of  these  may  be 
changed  and  even  the  current  of  the  river.  This  illustration 
may  help  to  make  clear  changes  in  the  contour  and  density  of 
the  alveolar  processes  depending  on  the  changes  of  blood- 
supply  and  absorption.  Irritation  may  thus  stimulate  the 
activity  of  the  capillaries  to  a  more  than  ordinary  degree  of 
repair. 

Every  tooth  exerts  a  pressure  of  its  own  in  different 
directions.  Were  this  not  so  it  would  be  difficult  to  account 
for  the  elongation  of  a  tooth  when  its  opponent  is  extracted. 
This  pressure  is  healthy  and  implies  the  antagonism  of  oppos- 
ing teeth.  If  this  occlusion  is  wanting,  the  relation  of  waste 
and  repair  is  disturbed.  An  excess  of  bone-cells  is  often 
deposited  as  a  result. 

When  these  two  fundamental  laws  of  good  occlusion  and 
balanced  waste  and  repair  are  violated  one  of  the  three  fol- 
lowing conditions  may  follow: 

1.  The  movement  of  individual  teeth  in  straight  lines. 

2.  The  rotation  of  individual  teeth  upon  their  axes. 

3.  The  forward  movement  of  groups  of  teeth  and  the 
alveolar  processes  supporting  them. 

THE  MOVEMENT  OF  INDIVIDUAL  TEETH  IN  STRAIGHT  LINES. 

It  was  stated  above  that  when  the  alveolar  processes  and 
teeth  correspond  in  size  and  the  occlusion  is  good,  that  spaces 


4»')J:  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

between  the  teeth  are  out  of  the  question.  Sometimes  a  space 
is  found  between  the  central  incisors.  If  the  occlusion  is 
o-ood  otherwise,  this  space  is  due  to  a  continuance  of  growth 
at  the  margin  of  the  suture — i.  e. ,  there  is  a  greater  deposit  of 
osseous  material  than  is  needed,  producing  a  larger  diameter 
of  the  jaw^  than  the  teeth.  This  begins  usually  at  an  early- 
period  in  life,  and  continues  till  the  growth  of  the  osseous  sys- 
tem has  ceased.  As  the  jaw  develops  in  the  child  while  the 
temporary  teeth  remain,  it  is  but  natural  that  spaces  should 
be  formed  in  time  until  the  permanent  teeth  take  their  place. 

Spaces  may  be  artificially  created  in  time  by  forcible 
separation  by  means  of  wedges.  In  former  years,  when  more 
force  was  applied  by  dentists,  irritation  was  created,  and 
absorption  on  one  side  induced.  In  this  way  several  teeth 
were  sometimes  crowded  in  one  direction.  When  the  anterior 
incisors  do  not  strike  on  a  line,  but  at  an  angle,  so  that  the 
cutting-edges  of  the  lower  incisors  strike  against  the  inclined 
plane  of  the  lingual  surface  of  the  upper  incisors,  an  out- 
ward pressure  is  exerted  and  the  incisors  separate.  The 
spaces  that  are  so  frequently  seen  in  the  permanent  incisors 
in  children  are  in  many  cases  produced  by  the  tardy  eruption 
of  the  cuspids.  When  the  cuspids  come  down  into  place  these 
spaces  disappear.  Spaces  are  rarely  if  ever  observed  between 
molars. 

Again,  the  lower  jaw,  if  too  large  for  the  upper  jaw,  may 
act  as  a  w^edge,  and  by  striking  against  it  may  spread  the 
central  suture.  The  spaces  between  these  teeth  are  usually 
found  to  be  healthy.  It  is  not  reasonable  to  suppose  that 
either  salivary  or  germinal  calculus  or  inflamed  gums  could 
produce  this  motion.  Were  tlie  pressure  exerted  on  one  side 
only  there  might  appear  to  be  some  ground  for  this  supposi- 
tion, providing  calculus  exerted  a  pressure  too  great  for  the 
rest  of  the  teeth  to  resist.  But  when  calculus  is  deposited  on 
both  sides  the  pressure  exerted  would  be  counterbalanced  and 
lateral  motion  could  not  take  place.  Those  who  hold  this 
opinion  are  probably  misled  by  the  fact  that  a  tooth  may  be 
dislodged  by  calculus  from  its  socket  vertically.  But  this  is 
in  accordance  with  mechanical  principles.     In  this  case  the 


THE    HEAD,    FACE,    JAWS    AND    TEETH  465 

calculus  diminishes  the  diameter  of  the  socket,  and  the  wedge- 
shaped  root  is  forced  out. 

KOTATION  OF  INDIVIDUAL  TEETH  UPON  THEIR  AXES. 

When  a  tooth  touches  its  opposites  only  at  one  point,  or 
the  opposing  tooth  was  extracted,  as  it  frequently  happens 
with  bicuspids,  instead  of  articulating  with  surfaces,  rotation 
may  result.  In  this  case  bone-cells  are  deposited  on  one  side, 
while  those  at  an  angle  with  these  are  removed.  This  pro- 
duces a  slight  rotation  which  twists  the  tooth.  That  this  pro- 
cess is  physiological,  is  proven  by  the  healthy  state  of  the 
gums  and  alveolus  which  is  found  in  most  of  these  cases. 
Fig.  216  not  only  shows  the  rot&ry  motion  to  the  bicuspids, 
but  also  spontaneous  motion  in  direct  lines — a  condition  fre- 
quently observed  by  the  author. 

THE  FORWARD  MOVEMENT  OF  GROUPS  OF  TEETH  AND  THE  ALVE- 
OLAR   PROCESS    SUPPORTING  THEM. 

,  In  young  persons,  when  the  blood  supply  is  rich  with 
nutritious  material,  and  when  waste  and  repair  go  on  rapidly, 
the  four  and  sometimes  six  anterior  teeth  and  alveolar  pro- 
cesses are  carried  forward.  This  proper  occlusion  with  the 
inferior  incisors  becomes  impossible,  and  these  become  elon- 
gated, and,  failing  to  find  a  support  in  the  upper  incisors, 
strike  against  the  roof  of  the  mouth.  Irritation  is  produced 
and  an  excessive  flow  of  blood  to  the  parts  follows.  Thus 
we  have: 

ANTERIOR     PROTRUSIONS    FROM     CONSTITUTIONAL    AND    LOCAL 

CAUSES. 

One  of  the  most  interesting  forms  of  irregularity  is  that 
in  which  the  inferior  incisors  impinge  upon  the  mucous  mem- 
brane of  the  roof  of  the  mouth  and  the  superior  centrals, 
laterals,  cuspids  and  bicuspids,  having  moved  forward,  pro- 
ject to  such  an  extent  that  the  upper  lip  cannot  close  over 
them.     It  should  be  observed: 

1.     That  these  cases  are  not  confined  to  normal  individu- 


466  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

als.  but   are   found   among  idiots,    deaf   and   dumb,    blind, 
demented  and  insane. 

2.  The  deformity  is  not  seen  in  temporary  teeth,  but  is 
confined  to  the  permanent  set,  beginning  at  the  seventh  or 
eight  year  and  increasing  with  age.  When  not  corrected  the 
teeth  will  finally  project  at  an  obtuse  angle,  as  is  illustrated 
by  a  case  of  a  woman  fifty-five  or  sixty  years  of  age  that 
came  to  our  notice,  whose  teeth  projected  almost  horizontally. 

3.  The  vault  connected  with  this  irregularity  is  usually 
low,  though  sometimes  high,  in  which  case  it  is  more  pro- 
nounced; just  as  V  and  saddle-shaped  arches  are  more  pro- 
nounced when  associated  with  a  high  vault. 

4.  The  irregularity  begins  at  the  central  incisors,  extend- 
ing backward. 

5.  Generally  later  in  life  tartar  collects  around  the  roots, 
and  Riggs'  disease  sets  in,  exaggerating  the  condition. 

6.  In  the  majority  of  cases  the  superior  maxilla  is' 
arrested,  and  the  teeth  project  at  an  angle  of  20°,  carr^ang 
the  alveolar  process  with  them,  in  order  that  they  may  strike 
over  the  lower  incisors. 

Dr.  Kingsle}^,  who  first  described  this  form  of  irregularity, 
is  right  in  his  statement  that  this  condition  is  neither  inherited 
nor  the  result  of  thumb-sucking.  The  conditions  under  which 
this  irregularity  is  brought  about  are  both  constitutional  and 
local.  It  should  be  noticed  that  the  excessive  proliferation  of 
bone-cells  does  not  begin  before  the  sixth  or  seventh  year, 
hence  not  until  the  permanent  teeth  are  erupted.  A  want  of 
balance  of  nervous  function,  resulting  from  neurotic  condi- 
tions or  a  transmitted  tendency  to  disease,  may  interfere  with 
the  centers  of  ossification,  which  interference,  as  has  been 
shown,  frequently  finds  expression  in  the  anterior  part  of  the 
mouth,  sometimes  producing  a  high  vault,  contracted  arches, 
excessive  or  deficient  deposition  of  bone-cells.  The  condi- 
tions are  mostly  confined  to  neurotics  and  degenerates.  An 
excessive  proliferation  of  bone-cells  near  the  median  line  of 
the  superior  alveolar  process  tilts  the  axes  of  the  erupting 
centrals  slightly  outward.  This  direction  once  being  given 
to  them,  when  the  lower  incisors  strike  against  them  they  do 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


467 


not  find  the  resistance  of  correct  occlusion,  but  act  upon 
them  as  upon  an  inclined  plane,  throwing  them  out  more  and 
more  during  the  process  of  eruption.  This  must  necessarily 
terminate  in  striking  the  process  itself;  increased  activity  of 
nutrition  which  irritation  sets  up,  resulting  in  excessive 
development,  which  also  shows  stigmata  of  degeneracy.  The 
tilting  forward  of  the  upper  incisors  increases  the  distance 
between  them,  and  the  lower  incisors  do  not  lind  the  resist- 
ance belonging  to  natural  function.     The  consequence  is  the 


Pig.  217. 


Pig.  218. 


Fig.  219. 


elongation  of  the  lower  anterior  alveolar  arch,  a  circumstance 
to  be  noted  in  these  cases.  The  eruption  of  the  first  per- 
manent molars  determines  the  relation  of  the  jaws  to  each 
other;  occasionally  they  do  not  develop  their  full  length.  In 
either  case  the  lower  incisors  strike  against  the  mucous  mem- 
brane of  the  "roof  of  the  mouth,  which  constant  irritation 
stimulates  the  deposition  of  the  bone-cells  in  the  process,  as  if 
nature  would  defend  it  against  the  abnormal  pressure  of  the 
lower  teeth.  Were  the  occlusion  correct,  the  constant  pressure 


468 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES 


on  the  roots  of  the  teeth  would  doubtless,  in  part,  counter- 
balance the  excessive  deposit  by  waste.  As  it  is,  the  roots  of 
the  upper  incisors  form  an  angle  with  the  cutting-edge  of  the 
lower  teeth,  and  as  the  mouth  opens  and  closes,  the  force  of 
the  lower  incisors  is  not  only  spent  on  the  superior  process, 
but  also  through  it  on  the  roots  of  the  upper  teeth,  forcing 
them  out  more  and  more.  Fig.  217  shows  the  starting-point. 
The  central  incisors  have  just  commenced  to  move  forward. 
The  model  is  from  the  mouth  of  a  girl  eleven  years  of  age. 
The  trouble  is  extended  to  the  neighboring  teeth  from  the 


Fig.  220. 


nature  of  the  occlusion.  Fig.  218  shows  the  incisors  and  alve- 
olar process  carried  forward  by  the  excessive  deposition  of 
bone-cells.  By  the  action  of  the  lower  lip,  which  cannot  close 
over  the  cutting-edges  of  the  upper  teeth,  but  soon  gets 
between  the  superior  and  inferior  incisors,  the  former  are 
pressed  out  still  more.  Fig.  219  shows  a  side  view  of  this 
form  of  irregularities.  Fig.  220  illustrates  a  remarkable 
case  of  migration  of  the  molars. 

Want  of  function  encourages  a  deposit  of  tartar  around 
the  roots  of  the  teeth,  inducing  Riggs'  disease  later  in  life 
and  loosenino:  the  teeth. 


CHAPTER  XXXV. 

SUPERNUMERARY  TEETH. 

Supernumerary  teeth  are  a  freak  of  nature,  for  which  no 
cause  has,  as  yet,  been  assigned.  It  may,  of  course,  be  stated 
that  additional  germs  were  formed  during  foetal  life,  but  this 
is  no  true  explanation,  for  the  question  still  arises,  "What 
caused  these  ? " 

Plants  put  forth  adventitious  buds  and  show  monstrosities 
in  all  their  organs;  animals  are  not  always  developed  accord- 
ing to  the  law  of  their  species;  the  human  race  shows  mon- 
strosities in  every  organ.  It  is  therefore  not  to  be  wondered 
at  that  we  see  additional  teeth.  They  were  noticed  by  the 
earliest  writers  on  dentistry,  even  before  Christ.  There  is  no 
doubt  that  what  the  public  calls  a  double  row  of  teeth  is  often 
merely  malposition  of  the  regular  number,  and  that  many  a 
supernumerary  tooth,  when  well  formed,  escapes  notice.  It 
is  best,  before  making  a  statement  in  doubtful  cases  as  to  the 
class  to  which  the  supernumerary  tooth  belongs  to  take  an 
impression;  then  it  can  be  studied  and  compared  with  the  rest 
at  leisure. 

Deviation  from  the  normal  number  is  more  marked  in  the 
permanent  than  in  the  temporary  set.  Little  mention  has 
been  made  of  deviations  in  number  in  the  deciduous  set, 
because  more  rare,  and  because  the  deciduous  teeth  have  less 
individuality  than  the  permanent  ones,  which  would  cause  an 
additional  tooth  to  escape  notice.  The  author  has  come  across 
four  cases  in  his  practice  of  supernumerary  laterals  in  decid- 
uous teeth.  Three  of  these  cases  presented  a  supplemental 
lateral  on  the  right  side  (Fig.  221);  the  fourth  had  them  on 
both  sides.  It  is  interesting  to  notice  that  the  excess  was 
found  mostly  on  the  right  side,  for  the  reason  that  greater 
development  of  organs  on  the  right  side,  includins:  the  jaw, 
have  hitherto  been  ascribed  to  more  frequent  use.  As  the 
germs  of  the  temporary  teeth  are  formed  before  birth,  this 
theory  cannot  stand  in  this  instance  at  least. 


470 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES  OF 


When  Ave  come  to  the  permanent  teeth  we  find  a  distinc- 
tion between  cases  presenting  merely  a  variation  in  number 
and  those  showing  malformed  supernumerary  teeth.  These 
may  be  considered  under  the  heads  of  supplemental  teeth  and 
monstrosities.  The  former  are  like  normal  teeth,  and  it  is 
difficult  to  distinguish  them  from  these.  The  contour  of  the 
latter,  like  that  of  all  monstrosities,  is  governed  apparently 
by  no  law,  excepting  a  want  of  definiteness.     However,  the 


Fig.  221. 


Fig.  222. 


root  is  conical  and  the  crown  may  be  lobed  or  have  the  appear- 
ance of  having  been  partially  folded  or  poorly  formed. 

Adventitious  teeth  are  more  f  requentl}^  found  in  the  upper 
jaw  than  in  the  lower.  It  is  a  rare  thing  to  find  a  well-formed 
supernumerary  central  incisor.  The  author  has  a  cast  show- 
ing five  equally  well  formed  incisors  in  the  lower  jaw. 
Whether  the  supernumerary  tooth  is  a  central  or  lateral  can- 
not be  determined  by  the  form.  Coleman  records  a  case 
having  four  well-formed  central  incisors  in  the  upper  jaw. 


THE     HEAD,    FACE,    -lAWS    AND    TEETH 


471 


Partially  developed  additional  incisors  are  not  rare.  These 
teeth  are  found  at  different  angles.  They  are  seen  erupting 
behind  the  arch,  in  front  of  it,  or  between  two  other  teeth. 
Fig.  222  shows  a  conical  tooth  between  two  ill-shaped  cen- 
trals, one  of  which  stands  almost  at  right  angles  with  the 


Fig.  223. 


Fig    224. 


Fig.  2 Jo. 


arch.     Another  case  still  more  interesting  (Fig.  223)  has  two 
central  monstrosities  separating  the  legitimate  centrals.   Fig. 

224  shows  two  supernumerary  centrals,  having  the  appearance 
of  being  convoluted,  between  the  usual  centrals.      In  Fig. 

225  we  see  two  supernumerary  central  teeth  between  the  lat- 
erals, all  of  which  are  placed  inside  the  regular  arch. 


472 


KTIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 


Laterals  in  excess  are  not  so  common  as  centrals.  These 
are  usually  more  like  the  normal  teeth.  Sometimes  they  are 
found  on  both  sides.  Fig.  226  shows  a  lateral  behind  the 
arch  and  between  the  central  and  the  lateral.  In  the  lower 
jaw  they  are  rare. 

In  Fig.  227  one  of  the  supernumerary  laterals  is  placed  back 


Fig.  227. 


Fig.  228. 


Fig.  229. 


of  the  right  cuspid  and  at  right  angles  with  it.  The  author 
has  two  models  similar  to  this  in  his  collection.  Cuspids, 
bicuspids  and  molars  are  not  often  found  in  excess. 

Fig.  228  shows  a  supernumerary  cuspid,  twisted  upon  its 
axis  on  the  risfht  side  of  inferior  maxilla.  The  right  lateral 
is  missing  and  the  cuspid  is,  no  doubt,  a  malformed  lateral, 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


473 


although  it  has  the  appearance  of  a  perfect  cuspid.  In 
Fig.  229  we  see  a  dental  anomaly  to  which  attention  is 
directed  by  Dr.  Rickey,  of  San  Francisco.  In  this  case  it  is 
difficult  to  say  which  is  the  supernumerary  tooth.  Fig.  230 
shows  four  well-formed  molars  in  each  side. 


Fig.  230. 


Fig.  231. 

Fig.  231  illustrates  a  very  rare  case  of  supernumerary 
teeth,  eight  in  all.  They  do  not  seem  to  be  confined  to  any 
one  class — incisors,  cuspids  and  bicuspids  seem  to  be  dupli- 
cated. This  cut  certainly  illustrates  a  double  set  of  teeth. 
The  model  is  in  the  Pennsylvania  College  of  Dental  Surgery. 


CHAPTER  XXXVI. 

MISSING  TEETH. 

That  teeth  are  frequently  missing  is  observed  by  every 
practitioner  of  dentistr}^  It  is  often  difficult  to  decide 
whether  the  germ  ever  formed  or  the  tooth  is  simply  imbed- 
ded in  the  alveolar  process.  Because  the  crown  of  the  tooth 
is  not  in  position  is  no  sign  that  it  did  not  develop.  The 
order  in  which  the  teeth  are  more  liable  to  develop  and 
become  imbedded  in  the  jaws,  as  observed  by  the  author,  are 
firsts  cuspids;  second^  third  molars,  and  thirds  bicuspids. 
There  are  g-ood  reasons  for  this—  the  fact  that  the  order  and 
manner  of  development  of  all  the  teeth,  and  the  development 
of  the  jaws,  reduce  the  space  for  the  advancement  of  the  cus- 
pid, bicuspid,  and  third  molars,  thus  causing  difficulty  for 
their  eruption. 

The  teeth  which  most  frequently  develop  and  become 
imbedded  in  the  jaw  are  firsts  cuspids;  second^  bicuspids. 
This  is  due  to  the  fact  that  owing  to  the  forward  movement 
of  the  posterior  teeth  or  other  causes,  the  germs  become  dis- 
lodged from  the  natural  position  and  point  in  another  direc- 
tion, thus  becoming  entangled  between  the  roots  of  the  teeth 
anterior  and  posterior,  and  in  this  way  are  unable  to  erupt 
into  the  mouth.  The  teeth  whose  germs  are  most  frequently 
undeveloped  are  firsts  third  molars,  and  second,  lateral  inci- 
sors. The  author  cannot  account  for  this  want  of  development 
in  any  other  way  than  that  it  is  the  result  of  stigmata  of 
degeneracy.  Some  time  ago,  out  of  G70  examinations  forty- 
six  per  cent  of  missing  third  molars,  and  fourteen  per  cent  of 
missing  laterals  were  found.  In  most  cases  the  missing  molars 
w^ere  upon  the  upper  jaw  and  upon  both  sides,  while  the  miss- 
ing laterals  were  always  upon  the  upper  jaw,  and  in  most 
cases  only  upon  one  side. 

At  the  time  of  the  examinations,  it  occurred  to  the  author 
that  it  was  a  very  large  percentage,  but  since  that  time  and 
while  making  further  observations,  he  is  confident  that  they 


THE    HEAD,    FACE,    JAWS   AND   TEETH  475 

are  always  found  in  neurotics  and  degenerates,  and  that  the 
reason  of  such  a  large  percentage  is  due  to  the  fact  that  my 
practice  is  made  up  largely  of  people  who  require  special 
treatment.  It  would  be  impossible  to  say  that  all  of  these 
germs  did  not  develop,  or  that  they  did  and  the  teeth  became 
imbedded  in  the  jaw  for  reasons  already  stated.  For  our  pur- 
pose, it  makes  no  difference  in  either  case,  the  cause  is  arrest 
of  development,  the  one  of  the  germs,  the  other  of  the  jaw, 
and  both  are  due  to  the  same  cause — neurosis  or  degeneracy. 


CHAPTER  XXXVU. 

THUMB  AND  FINGER-SUCKING. 

In  the  chapter  on  refutation  of  old  theories  regarding  the 
etiology  of  irregularities  of  the  jaws  and  teeth,  the  author 
has  stated  his  reasons  why  the  high  vault  and  the  V  and  sad- 
dle-shaped arches  cannot  be  ascribed  indiscriminately  to 
thumb-sucking,  as  has  been  the  custom. 

Hitherto  the  greatest  confusion  of  ideas  has  been  current 
among  practitioners  as  to  the  etiological  differentiation  of 
these  cases.  It  behooves  the  author  to  describe  the  condi- 
tions that  are  due  to  thumb-sucking  in  such  a  way  that  the 
student  may  be  aided  in  making  a  diagnosis.  In  cases  of 
irregularities  due  to  thumb-sucking  we  find  several  teeth  and 
the  alveolar  process  brought  forward.  Frequently  spaces  are 
found  between  them,  so  that  they  stand  out  more  and  more 
fan-shaped.  The  vault  may  be  high,  but  is  usually  low  like 
that  seen  in  Fig.  234.  The  teeth  are  frequently  affected  only 
on  one  side,  the  shape  and  extent  depending  upon  the  direc- 
tion of  the  force  and  the  hand  employed  in  sucking.  In  the 
V-shaped  arch  the  teeth  are  crowded  and  point  toward  the 
center,  owing  to  a  force  applied  by  the  posterior  column  and 
spent  on  both  halves  toward  the  median  line.  The  vault  may 
or  may  not  be  arched.  In  the  saddle-shaped  arch  the  teeth 
are  crowded,  except  in  cases  due  to  hypertrophy,  and  they 
stand  perpendicular.  The  vault  may  be  high  or  low.  In 
cases  of  thumb-sucking,  the  teeth  of  the  inferior  maxilla  do 
not  articulate  properly  with  the  upper,  and  are  often  turned 
inward,  which  is  caused  by  the  pressure  of  the  thumb  upon 
the  cutting-edges.  We  see  from  this  that  the  distinguishing 
feature  of  a  case  of  thumb-sucking  is  the  spreading  of  all  or 
a  part  of  the  anterior  teeth,  and  that  the  lower  teeth  are 
usually  turned  inward. 

When  the  vault  is  high,  it  is  quite  marked  in  the  anterior 
portion  of  the  roof  of  the  mouth;  but  this  is  by  no  means  a 
characteristic  feature.    As  the  habit  of  thumb-sucking  usually 


THE    HEAD,    FACE,    JAWS    AND   TEETH 


477 


terminates  before  the  eruption  of  the  permanent  teeth,  cases 
of  irregularities  resulting  from  thumb-sucking  in  children 
over  ten  years  of  age  are  rare,  ([t  will  be  of  interest  to  the 
student  to  note  a  number  of  cases  that  have  come  under  the 
observation  of  the  author.) 

Babies  usually  commence  to  suck  their  fingers  within  a 
few  hours  after  birth, — in  the  majority  of  cases  not  later  than 
the  first  week.  The  habit  is  therefore^  well  fixed  before  the 
temporary  teeth  begin  to  erupt.  This  being  the  case,  the 
teeth  and  the  alveolar  process  are  naturally  affected  in  their 
development  if  the  pressure  is  continuous.  The  extent,  shape 
and  location  of  the  irregularity  depends  upon  the  hand 
employed  and  the  position  of  the  thumb  and  finger  used. 
The  right  or  left  side  are  affected  according  to  the  hand  used, 
though  occasionally  we  find  it  in  the  median  line. 


As  the  child  usually  discontinues  the  habit  before  the 
time  of  the  eruption  of  the  permanent  teeth,  deformities  pro- 
duced by  thumb-sucking  are  usually  confined  to  the  tempor- 
ary set. 

Fig.  232  shows  the  forward  movement  of  the  right  central 
and  lateral  incisor.  The  model  was  taken  from  an  impres- 
sion of  the  teeth  of  a  little  girl  two  and  a  half  years  of  age. 
While  in  the  act  of  sucking,  the  right  arm  rested  upon  the 
breast,  and  the  ball  of  the  thumb  was  directed  against  the 
palatine  surfaces  of  the  incisors,  which  were  carried  forward. 
The  child  discontinued  the  habit  at  four.  It  will  be  observed 
that  while  the  cutting-edges  of  the  teeth  have  been  slightly 
pressed  forward,  and  a  \ery  slight  impression  has  been  made 
on  the  alveolar  process,  none  was  made  on  the  roots  of  the 
teeth,  and  consequently  no  deformity  exists  where  the  germs 


y 


478 


ETIOLOGY  OF  OSSEOUS   DEFORMITIES   OF 


of  the  permanent  teeth  are  located.  After  the  child  discon- 
tinued the  habit,  the  teeth  soon  returned  to  their  natural 
position,  aided  by  the  pressure  from  the  lip.  At  this  age  the 
absorption  and  deposition  of  bone-cells  is  so  active  that  very 
marked  deformities  are  frequently  corrected  before  the  tem- 
porary teeth  are  lost,  providing  that  the  habit  ceases  in 
infancy. 

Fig.  233  shows  quite  a  different  deformity.  Here  we  see 
the  teeth  fully  developed,  but  a  marked  deformity  existing 
at  the  median  line.  This  case  is  that  of  a  child  six  years  of 
asfe.  The  thumb  was  held  in  the  mouth  so  that  the  teeth 
came  in  contact  with' the  thumb  at  right  angles,  preventing 
the  development  of  the  alveolar  process.     The  teeth  of  the 


Fig.  233. 

inferior  maxilla  do  not  articulate  properly  with  those  of  the 
superior,  which  is  caused  by  the  thumb  having  rotated  upon 
the  lower  teeth  after  the  upper  had  closed  upon  them.  The 
hard  palate  was  flat  and  normal,  showing  that  the  pressure 
was  direct  upon  the  teeth,  and  that  the  thumb  did  not  come 
in  contact  with  the  tissues  of  the  mouth.  When  the  habit  is 
continued  during  the  development  of  the  permanent  set,  the 
deformity  is  more  marked,  because  there  is  more  leverage,  as 
is  shown  in  Fig.  234.  This  is  a  case  in  which  the  palate  is 
flat  and  normal,  showing  that  the  pressure  was  direct  upon  the 
teeth,  and  that  the  thumb  did  not  come  in  contact  with  the 
tissues  of  the  mouth.  The  superior  jaw  and  teeth  are  brought 
forward  by  absorption  and  deposition  of  bone-cells,  and  the 
lower  teeth  and  jaw  are  carried  inward. 


THE     HEAD,    FACE,    JAWS   AND   TEETH 


479 


These  cases  are  so  unlike  those  of  any  other  form  of  irregu- 
larity of  the  permanent  set  that  it  would  seem  impossible  to 
overlook  the  cause.  The  alveolar  process  and  teeth  assume 
the  shape  of  the  object  or  thing  sucked. 

Fig.  235  shows  the  front  view  of  a  case  of  thumb-sucking. 
The  teeth  have  developed  their  normal  length;  but  arrest  of 


Fig.  2.^4. 


Fig.  235. 

development  of  the  superior  alveolar  process  has  taken 
place  similar  to  Fig.  23.S.  In  Fig.  235  there  has  been  quite  a 
protrusion  and  forward  movement  of  superior  incisors  and 
alveolar  process,  the  teeth  standing  fan-shaped.  The  lower 
incisors  are  pressed  inward  and  crowded  together.  The  space 
is  greater  on  the  right  side  than  on  the  left,  showing  that  the 
right  hand  was  used. 


CHAPTER  XXXVIII. 

CONCLUSIONS. 

The  various  influences  which  are  brought  to  bear  upon 
the  present  races  of  the  earth  which  result  in  neuroses  of 
degeneracy,  in  excessive  and  arrested  development  of  the 
osseous  system,  have  been  discussed.  Excessive  and  arrested 
development  of  the  osseous  system  may  be  a  direct  inheri- 
tance. The  children  will  possess  structures  similar  to  those 
of  one  or  both  parents,  as  when  a  child  inherits  an  upper  jaw 
from  one  parent  and  a  lower  jaAV  from  the  other,  or  inherits  the 
jaws  from  one  parent  and  the  teeth  from  the  other.  Again,  in 
a  family  of  five  children,  four  may  inherit  the  jaws  and  teeth 
of  the  father,  and  the  fiflh  the  jaws  and  teeth  of  the  mother. 

y  A  neurotic  brain  may  be  transmitted  which  presides  over  the 
development  of  the  osseous  system,  and  thus  occurs  excessive 
or  arrested  development  in  the  natural  growth  of  the  osseous 
system.  It  is  a  singular  fact,  there  seems  to  be  a  tendency  for 
neurotic  individuals  to  seek  each  other's  society.  Hence  the 
large  number  of  literary  societies  which  are  being  formed 
throughout  the  country,  entertainments  and  social  gatherings 
at  which  brilliant  men  and  women  are  to  be  found.  These 
individuals  not  only  seek  each  other's  society,  but  marriages 
are  the  rule  among  them.  As  a  result  children  are  born, 
who,  if  they  live,  in  many  cases  become  geniuses  or  possess 
unbounded  egotism.  They  may  become  idiotic,  deaf  and 
dumb,  blind,  or  late  in  life,  insane,  criminals  or  drunkards. 

^Dr.  Bannister,*  after  citing  several  instances  in  which  the 
degenerate  intermarried,  expresses  the  opinion  that  such  mar- 
riages constitute  a  potent  factor  in  the  perpetuation  of  neu- 
roses. Similar  opinions  are  expressed  by  Dr.  J.  G.  Kiernan  f 
from  observations  of  similar  cases.  He  refers  the  degener- 
acy of  genius  to  this  factor.  Genius  attracts  abnormal 
females  as  lighthouses  do  birds.     Dr.  Manning  %  has  found 

*  American  Lancet,  Vol.  VII. 

i  Xeurological  Review,  Vol.  I.;  Alienist  and  Neurologist,  Vol.  XIII. 

X  Australian  Medical  Gazette,  1885. 

480 


THE     HEAD,    FACE,    JAWS    AND    TEETH  481 

that  the  peculiar  sympathy  which  the  neurotics  have  for  each 
other  often  results  in  marriage.  The  peculiarities  of  persons 
who  visit  their  wives  and  husbands  in  insane  hospitals  are 
most  remarkable,  and  it  sometimes  happens  that  the  appar- 
ently least  insane  member  of  the  family  is  under  care,  while 
the  seemingly  most  pronounced  lunatic  is  at  large.  Nesbit,*^ 
from  his  studies  on  genius,  forms  the  conclusion  that  neuro- 
paths seem  to  be  draAvn  to  each  other.  The  most  remarkable 
illustration  of  this  fondness  of  neurotics  for  each  other  is 
demonstrated  in  the  Keeley  hospital  at  Dwight,  Illinois. 
Here  are  seen  men  of  all  professions,  trades  and  occupations, 
mingling  together  in  the  most  social  manner.  It  will  also 
account  for  the  large  number  of  "gold  clubs  "  which  are  being 
organized  in  diflFerent  parts  of  the  country.  This  sociability 
and  affection  are  carried  to  the  extent  that,  in  most  cases, 
cards  are  exchanged  as  tokens  of  remembrance  and  for  the 
purpose  of  correspondence. 

Such  marriages  as  are  here  mentioned  are  great  factors  in 
the  production  of  a  class  of  people  whom  we  might  expect  to 
be  not  only  deficient  in  mental  stability,  but  also  in  their 
osseous  system.  Reasoning  from  this  standpoint  we  would 
naturally  expect  to  find  an  increase  in  abnormalities  in  older 
countries,  where  heredity  is  more  concentrated.  Thus,  we 
would  expect  to  find  more  deformities  in  people  living  in 
New  England  than  in  the  West;  a  still  larger  percentage  in 
England  and  Europe  than  in  New  England.  Extending  our 
investigations  still  further  we  would  expect  to  find  more  neu- 
roses and  degeneracy  among  the  nobility  of  Europe  than 
among  the  middle  and  lower  classes.  Mr.  Cartwright  recog- 
nized the  fact  when  he  said  that  "Irregularity  is  common  in 
most  highly  civilized  communities,  and  especially  so  among 
the  upper  and  middle  classes."  In  accounting  for  the  con- 
dition, he  says  that  it  is  the  result  of  high  and  selective 
breeding,  and  supports  his  position  by  illustration  of  the 
results  of  high  breeding  among  animals. 

The  comparison  of  uniting  families,  whether  of  nobility 

*  Insanity  of  Genius,  p.  325. 


482  ETIOLOGY  OF  OSSEOUS  DEFORMITIES  OF 

or  otherwise,  to  the  selective  breedino:  of  animals  is  not  fully 
justified.  In  the  one  case,  especially  that  of  royal  families, 
physical  and  mental  conditions  are  rarel}^  taken  into  consider- 
ation. The  main  point  is  the  retention  of  position  and  rank 
socially  and  financially.  The  physical  conditions  are  almost 
entirely  ignored;  the  result  is  that  neuroses  and  degeneracy 
have  penetrated  ever}^  household,  stamping  themselves  not 
only  upon  the  osseous,  hut  all  the  dift'erent  systems  of  the 
human  body.  This,  then,  is  selective  breeding  involving  posi- 
tion and  wealth.  On  the  other  hand,  selective  breeding  of 
animals  applies  to  their  physical  condition;  "low  breeding" 
instead  of  "  high  breeding  "  would  be  a  preferable  term. 
y  In  families  where  neuroses  and  stigmata  of  degeneracy 
have  been  handed  dowai  for  a  number  of  generations,  the 
deformities  seem  to  be  more  markedly  defined,  aind  a  large 
number  result  in  one  individual.  This  accounts  for  the  larger 
number  of  criminals  and  paupers  in  Europe  than  in  this  coun- 
try, and  the  more  marked  deformities  of  the  head,  face,  and 
jaws,  as  illustrated  by  Tarnowsky  and  Lombroso  in  their 
books,  and  in  the  magnificent  exhibit  of  criminal  anthropol- 
ogy by  M.  Bertillon  at  the  World's  Fair.  When  such  cases 
are  found  they  are  usually  of  foreign  birth.  Deformities  of 
the  jaws  seem  to  be  more  easily  recognized  than  deformities 
of  other  bones,  because  the  least  deviation  in  the  one  or  the 
other  is  observed,  owing  to  their  close  proximity  and  the 
occlusion  of  the  teeth.  Deformities  of  the  teeth  are  also  very 
readily  noticed.  Adenoid  growths,  polypi,  hypertrophy  and 
atrophy  of  the  bones  and  mucous  membrane  of  the  nose  are 
more  common  among  neurotics  and  degenerates,  and  the  con- 
clusion must  be  that  they  are  the  result,  first,  of  an  unbal- 
anced nerve  function,  producing  unstable  blood-sUpply,  and 
second,  of  an  unbalanced  bony  framework.  Tarnowsky  and 
other  scientists  make  quite  a  point  of  the  atavistic  characters 
of  one  or  two  teeth.  We  must  pot  lose  sight  of  the  fact,  how- 
ever, that  many  teeth  deformities  are  due  to  local  causes, 
and,  therefore,  are  not  stigmata  of  degeneracy.  Elsewhere 
irregularities  of  the  teeth  have  been  classified  into  consti- 
tutional and  local.      There  is  quite  a  diflerence  between  the 


THE    HEAD,    FACE,    JAWS   AND   TEETH  483 

two  varieties.  The  constitutional  variety  always  involves  the 
jaw  bone,  develops  with  the  osseous  system,  and  are  stigmata 
of  degeneracy.  The  local  irregularities  (one,  two  or  three 
teeth  involved)  are  due  to  local  causes,  such  as  improper  erup- 
tion, early  or  later  extraction  of  the  temporary  teeth.  They 
should  not  be  considered  in  a  diagnosis  in  connection  with 
neuroses  or  degeneracy.  The  author  agrees  in  toto  with 
Dr.  Alice  Sollier,  that  '"dental  anomalies  are  very  common 
in  degenerates,"  and  would  go  still  further  and  include 
neurotics. 

The  loss  of  the  third  molar  and  lateral  incisor  and 
deformities  of  the  teeth  are  certainly  signs  of  degeneracy, 
and  are  always  noticed  in  arrest  of  development  of  the  bones 
of  the  face  and  jaws.  Many  cases  occur  in  which  degeneracy 
is  stamped  upon  the  face,  while  the  teeth  and  alveolar  process 
are  normal.  The  teeth  of  both  jaws  erupt  and  crowd  their 
way  into  a  normal  position,  thus  showing  that  the  jaws  and 
teeth  are  regular,  but  the  depression  from  the  alee  of  the  nose 
upward  is  quite  deformed.  In  the  eruption  of  the  teeth 
nature  asserts  her  rights  and  comes  to  the  rescue.  With  all 
these  conditions  grouped  under  the  two  heads — neuroses  and 
degeneracy — it  is  not  strange  that  they  should  crop  out  in 
some  form  in  nearly  every  family.  Hence,  inherited  condi- 
tions will  destroy  many  families  in  the  fourth  to  the  sixth 
generation. 

From  the  study  and  comparison  of  the  face,  as  illustrated 
in  the  chapter  on  "Deformities  of  the  Face"  (with  the 
pictures  and  descriptions  in  chapter  upon  "Development  of 
the  Face  "),  it  is  evident  in  every  instance  there  is  arrest  of 
development  at  some  period  in  the  evolution  to  the  sixth 
year. 

Fig.  54  shows  arrest  at  the  bridge  of  the  nose,  while 
all  other  bones  developed  their  normal  size.  This  is  the 
earliest  arrest  that  could  take  place.  Fig.  55  shows  arrest 
still  later  in  life,  and  so  on  until  we  reach  Fig.  60.  Arrest 
of  the  lower  jaw  may  also  take  place  at  any  period  in  its 
development.  All  these  conditions  not  only  show  arrest 
at  some  period  in  the  early  life  of  the  child,  but  also  show 


484  ETIOLOGY  OF  OSSEOUS  DEFORMITIES 

atavism,  since  these  faces  are  found  in  many  of  the  different 
races,  such  as  the  negro,  Javanese,  Bedouins,  Esquimaux, 
and  some  tribes  of  Indians,  as  illustrated  in  Fig.  6. 

The  fact  has  also  been  demonstrated  that  a  person  with  a 
constitutional  disease  producing  arrest  of  development  of  the 
jaws  and  facial  bones  may  transmit  them  to  his  offspring,  who 
inherit  qualities  which  are  acquired  in  the  parent. 

Nothing  has  been  said  in  regard  to  hereditary  taint,  such 
as  disease,  deformities,  etc.,  becoming  aborted  in  the  offspring 
as  a  result  of  marriage.  Such  is  frequently  the  case,  but  as 
this  condition  in  no  way  enters  into  the  subject  under  dis- 
cussion, it  will  be  dismissed  with  this  brief  mention. 

Great  stress  has  been  laid  upon  the  excessive  development 
of  the  lower  jaw  by  some  physiognomists,  in  that  it  denotes 
strength  and  firmness  of  character,  while  my  experience  is 
that  very  little  can  be  determined  by  it  alone.  Other  signs 
must  be  taken  into  consideration  before  one  can  decide  upon 
character  by  the  size  and  shape  of  the  lower  jaw.  The  lower 
jaw  is  formed  independent  of  the  other  bones  of  the  head,  and 
movable;  it  develops  normally  or  is  arrested.  If  excessively 
developed  or  arrested,  it  is  just  as  liable  to  denote  mental 
weakness  as  strength  of  character.  This  leads  to  the  dis- 
cussion of  the  reason  why  criminals,  prostitutes,  drunkards, 
and  in  fact,  all  degenerates,  possess  stigmata.  It  should  be 
remembered  that  degeneracy  may  lightly  touch  an  organism 
or  deeply  affect  it.  The  fact  that  stigmata  of  degeneracy  in 
a  light  degree  are  often  found  among  otherwise  apparently 
normal  persons,  indicates  that  environment  has  much  to  do 
with  the  progress  of  development  of  degeneracy.  Whether 
stigmata,  as  has  been  shown  in  children,  are  inherited  or  are 
the  result  of  constitutional  disease,  they  should  equally  receive 
constant  attention  of  their  parents,  and  should  be  sur- 
rounded with  all  the  healthy  comforts  and  influences  of  home 
life.  Their  associates  should  be  carefully  selected  until  they 
have  attained  maturity,  or  until  their  character  is  fixed. 
With  this  early  careful  attention  from  parents  there  would  be 
fewer  criminals,  fewer  drunkards,  prostitutes  and  paupers  in 
our  charitable  and  correctional  institutions. 


CHAPTER  XXXIX. 

EXPLANATION  OF  PLATES. 

Plates  1  to  6  are  lithographic  illustrations  of  the  upper 
jaws  of  boys  from  an  orphan  asylum,  ranging  from  six  to 
twelve  years  of  age.  They  are  drawn  from  casts  of  the  mouths 
taken  as  they  were  sent  into  the  office  of  the  institution  by 
the  superintendent,  regardless  of  condition,  the  only  point 
taken  into  consideration  being  the  age.  The  object  of  these 
illustrations  is  to  show  the  progress  of  the  development  of 
the  second  teeth,  their  relations  to  the  temporary  ones  and 
also  to  the  jaw.  Notice  the  date,  manner  and  formation  of 
the  normal  V  and  saddle-shaped  arches  and  their  modifica- 
tions. 

Plates  7  to  17  show  the  shape  of  the  teeth,  alveolar  pro- 
cess, and  vault  at  the  median  line  of  the  above  cases. 

Plates  8  to  18  show  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  a  line  drawn  laterally  anterior  to  the  first 
permanent  molar  of  the  above  cases. 

Plates  19  and  21  illustrate  the  shape  of  the  teeth,  alveolar 
process  and  vault  at  the  median  line,  of  twelve  brachy cephalic 
white  adults.  (For  measurements  of  these  cases  see  pages 
344  to  347.) 

Plates  20  and  22  illustrate  the  shape  of  the  teeth,  alveolar 
process  and  vault  at  a  line  drawn  laterally  anterior  to  the 
first  permanent  molar,  of  twelve  brachycephalic  white  adults. 

Plates  23  and  25  show  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  the  median  line,  of  twelve  mesocephalic  white 
adults. 

Plates  24  and  26  show  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  a  line  drawn  laterally  anterior  to  the  first 
permanent  molars  of  twelve  mesocephalic  white  adults. 

Plate  27  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  median  line  of  six  dolichocephalic  white  adults. 

485 


4^0  ETIOLOOY  OF  OSSEOUS   DEFORMITIES    OF 

Plate  2s  shows  the  sliape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  tirst  per- 
manent molar  of  six  dolichocephalic  white  adults. 

Plate  29  shows  the  shape  of  the  teeth,  alveolar  process 
and  the  vault  at  the  median  line  of  six  brachycephalic  colored 
adults. 

Plate  30  shows  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  tirst  per- 
manent molar  of  six  brachycephalic  colored  adults. 

Plate  31  shows  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  raesocephalic  colored 
adults. 

Plate  32  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar  of  six  mesocephalic  colored  adults. 

Plate  33  shows  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  dolichocephalic  colored 
adults. 

Plate  34  shows  the  sliape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  perma- 
nent molar  of  six  dolichocephalic  colored  adults. 

Plate  3.5  illustrates  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  the  median  line  of  six  V-shaped  vaults  of 
white  adults. 

Plate  36  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  perma- 
nent molars  of  six  V-shaped  vaults  of  white  adults. 

Plate  37  illustrates  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  the  median  line  of  six  semi- V-shaped  vaults 
of  white  adults. 

Plate  38  illustrates  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  a  line  drawn  laterally  anterior  to  the  first 
permanent  molars  of  six  semi-V-shaped  vaults  of  white  adults. 

Plate  39  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  saddle-shaped  vaults  of 
white  adults. 


THE    HEAD,    FACE,    JAWS   AND   TEETH  487 

Plate  40  illustrates  the  shape  of  the  teeth,  alveolar  pro- 
cess and  vault  at  a  line  drawn  laterally  anterior  to  the  first 
permanent  molars  of  six  saddle-shaped  vaults  of  white  adults. 

Plate  41  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  semi -saddle  shaped  vaults 
of  white  adults. 

Plate  42  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  perma- 
nent molar  of  six  semi- saddle  vaults  of  white  adults. 


PLATE  1 


PLATE  2 

8  YEARS. 


10 


\e 


PLATE  3 

9  YEARS. 


14 


IS 


PLATE    A^ 

lO  YEARS. 


19 


20 


22 


■^'^'^^^^iU^^ 


23 


PLATE  5 

1 1  YEARS. 


25 


26 


29 


PL.ATE  S 

12  YEARS. 


31 


32 


33 


34 


35 


ANTERO-POSTERIOR  AND   LATERAL 
ILLUSTRATIONS  OF  THE  VAULT 


PLATE     7 

^ix  yc<rr5  of  qcre . 


3evctt  yaqrs  ofaofc. 


3cv^n  yeqr5  ofade . 


5. 


PLATE     9 


PLATE  dO 


Cight"year5  of  qgc 


\o 


(I 


U. 


PLATE  Id 


PLATE  12 

NiM«  years  of  og«. 


15. 


16 


17. 


PLATE  13 


Ten  y«<ir»  of  cqc . 
7? 


PLATE  14 


Ten  years  of  q^i 


24 


PLATE  15 


PLATE  16 

Ckven  y«qr5  of^ogc. 


2J 


^S 


z<i 


PLATE   17 

Tw«/ve  yvan  of  ag'c. 


PLATE  48 

Twelve  ye cirs  of  a^e  . 


54- 


35. 


56. 


PLATE  19 

Brqchycc/ihq/i'c.  Whrti 


PLATE  20 
Bwcfiycefilrclic.  White. 


PLATE  21 

£i'cicfiytejifi<)lic.    White. 


PLATE  22 

Brachyce/ihqlic.  WfiiTe 


PLATE  23 

Mesoccfihqlic.    Wftife 


PLATE  24 

Nesoce/ihalic .  Whife 


PLATE  25 

Mesoce/thqiic.  White 


PLATE  26 


Mesoccfihafic.  \^^h^t'z 


PLATE  27 


Dolichocehhalic   Whife 


PLATE  28 
Dolichoccfiholic.  Whik. 


PLATE  29 

Brqchyc«fihqlic.   Color«cl 
7 


PLATE  30 

^mcfiycejifiqlic.  Color (?J 


5. 


PLATE  3d 


Me50ccfifiglic.  Caiomcj. 


PLATE  32 

Mesocefihqlic.  Colored. 


IZ. 


PLATE  33 


Dolichocejihalic.  Colored. 


PLATE  34 


Dolichocc|ihalic.  Colored- 


PLATE  35 
V  Jhqhed  Vquir. 


PLATE  36 

V  ihqfieci  Vault. 


PLATE  37 
5eTni  V3ha|ie(J  Vqult 


PLATE  38 
5emiV5fiaftecl  Voulf". 


PLATE  39 


3q(/c//e-5l^a^ecf  Vaulr. 


PLATE  40 
Saddle  shajiec]  Vciixlt 


3. 


4- 


PLATE  41 
5em  I  -  SQJcfle  VJTirff 


PLATE  42 
5emi- saddle  V&ult: 


5. 


INDEX 


Absorption  and  Nutrition 462 

Acceleration   and   Retardation   of 

Development 50 

Acquired  Peculiarities,  Inheritance 

of 43 

Adventitious  Teeth 470 

African,  Change  of  Shape  of  Head 

in 35 

Alaska  Indians,  Skulls  of 263 

Alexander,  H.  C.  B,,  on  Instincts 

of  Children :.184 

On  Prostitution 163 

Alveoli,  Hypertrophy  of 108,  393 

Alveolar  Process,  Development  of  97 

Enlargement  of 102 

Excessive  Size  of 105 

Inferior 99 

Structure  of 351 

Ancient  Romans,  Jaws  of 67 

Andronico,  on  Prostitution 166 

Angles  and  Saxons  in  England 33 

Anglo-Saxons,  Jaws  of 69,  73 

Animals,  Changes  in 21 

Antrum 267 

Description  of 281 

Diseases  of 291 

Drainage  of 288 

Neuroses  of  Development  of. .  281 

Septa  in 290 

Variations  in 282 

Anterior  Protrusion  of  Teeth 465 

Arabs,  Varieties  of 28 

Arch,  Normal 402 

Contracted  352 

Saddle-shaped 419 

^  Semi-saddle 424 

V-shaped 401 

Semi  -V-  shaped 413 

Partial  V-  shaped 411 

Arrest  of  Development  of  Teeth. .  .228 
Arthur,  on  Dental  Irregularities. . .  12 

Asymmetry  of  Maxillae 308 

Athenians,  Jaws  of 66 

Australians,  Jaws  of 68 


PAGE 

Ballard,  Thos.,  on  Thumb-suck- 
ing  3,  329 

Bannister,  H.  M.,  on  Epileptic 
Facies 176 

On  Intermarriage  of  Degen- 
erates   480 

Barth,  Ruspini,  on  Supernumerary 

Teeth 2 

Beaunis  and  Bouchard,  on  Develop- 
ment of  Pace 400 

Belgian  Gauls  in  England 33 

Bell,  Thos.,  on  Dental  Irregulari- 
ties       7 

Bemis,  S.  M.,  on  Intermarriage. .  .212 
Benedikt,  on  Abnormality  of  Struc- 
ture   81 

Berdmore,  Thos.,  on  Retention  of 

Teeth 1 

Bertillon,  on  Bodily  Asymmetry. .  .309 
Bicuspids,  Deflection  of 447 

Inferior,  Irregularities  of  . . .  .460 

Malposition  of 445 

Tardy  Eruption  of 447 

Black  Race,  Shape  of  Head  in 34 

Blake,  R.,  on  Supernumerary  Teeth    2 
Blind,  the,  Facial  Deformities  in.  .299 
Blount,  A.  A.,  on  Dental  Irregulari- 
ties    14 

Booth,  Mrs.  Ballington,  on  Prosti- 
tution   161 

Bosworth,  OD  Development  of  An- 
trum   282 

On  Projection  of  Vomer 270 

On  Septum 255 

Brachycephalic  Heads 341 

Brachycephalic  Type 34 

Brederman,  W.  K.,  on  Dental  De- 
formities   12 

Britain,  Races  in 33 

Britons,  Early,  Size  of  Jaws  of ... .  33 
Broca,  Classification  of  Crania. . .  .341 

On  Type  of  Head 34 

Brown,  Dr 360 


11 


INDEX 


Buccinator  Muscle,  Action  of 851 

Bushmen,  -Jaws  of 55,  G8 


Camper,  on  Facial  Angle 2H1 

Canine  Eminence 99 

Cantile,  -J.,  on  City  Life .221 

Canton,   Alfr.,   on  Dental  Irregu- 
larities    12 

Carter,  on  Decay  of  Teeth 79 

Cartwright,  S.,  on  Close  Breeding.  118 

On  Deformities 481 

On  Dental  Irregularities 18 

Catlin.  Geo.,  on  Mouth-breathing.  10 

Celtic  Language  in  Britain 83 

Cheek  Bones 58 

Children.  Degenerate,  Rearing  of.  .484 

Chinese,  -Jaws  of 67,  68 

Chinese  and  Japanese 27 

City  Life,  Causes  of  Danger  in 222 

City  versus  Country  Life 221 

Civilization     and    Dental    Irregu- 
larity      9 

Clark,  A.  on  Dental  Irregularities  .  11 
Clark.  .J.  P.,  on  Dental  Irregulari- 
ties       9 

Classification  of  Dental  Irregulari- 
ties    16 

Clay  Shaw,  on  High  Vault 328 

Cleft  Palate,  Acquired 397 

Classes  of 397 

Congenital 397 

Embryology  of . : 395 

Etiology  of 395 

Frequency  of 399 

In  Animals 399 

Transmission  of .398 

Clevenger,  on  High  Cheek-bones. . .  53 

Climate,  Changes  of 18 

Close  Breeding 113 

Clouston,  on  Deformity  of  Suture. 385 

On  Neurotic  Children 184 

On  Vault .380 

Coleman  and  Cartwright,  on  Den- 
tal Irregularities 10 

Coles,  Oakley,  on  Cleft  Palate  396.  897 

On  Oral  Deformities 204 

On  Measurement  of  Skull 93 

On  Dental  Irregularities 9 

Cope.  E.  D..  on  Physiognomy 47 

Combinations    of    V   and  Saddle- 
shaped  Arches 426 


PAGE 

Comparative  Degeneracy  of  For- 
eigners and  Americans 250 

Compensatory  Development 251 

Conclusions 480 

Consanguinity  of  Parents 209 

Constitutional  Causes  of  Irregulari- 
ties    11 

Constitutional  Lesions 227 

Contracted  Arches. 352 

Contracted  Jaws 349 

Cravens,  J.  E.,  on  First  Permanent 

Molar 449 

Cretins,  Jaws  of 66 

Crime,  in  Animals 119 

In  Plants 119 

Criminals,  Deformities  of  Jaws  in  159 

Left  Handedness  in 136 

Skulls  of 137 

Crooke,   Hilkiah,  on    Number    of 

Teeth 1 

Cuspids,  Importance  of 441 

Inferior,  Irregularities  of  . . .  .458 

Malposition  of 441 

Cuylitz.  on  High  Vault 328 


Dahl,  Ludwig,  on  Idiocy  in  Nor- 
way   198,  212 

Darwin,  on  Effects  of  Mental  Con- 
centration   190 

On  High  Cheek-bones 53 

Davenport,  on  First  Molar 453 

Deaf  and   Dumb,  Deformities   of 

Jaws  in 301 

Deaf  Mutism 300 

Deformities  of  Suture, 385 

Deformities  of  Vault 883,  .393 

Deformities,    Percentage    of,    in 

Different  Countries 481 

Degeneracy.  Doctrine  of 115 

Of  Foreigners  and  Americans  250 

Of  Jaws  and  Teeth 56 

Table  of 117 

Degenerates,  Deformities  of 115 

Immigrants  in  United  States .  .32 

Intermarriage  of  480 

Delabarre,   C.   F..   on  Dental  De- 
formity    13 

De  Lande,  Chas.,  on  Dental  Irregu- 
larity       8 

De  Lessert.  A.  A.,  on  Sucking 4 


INDEX 


111 


■PAGE 

De  Quatrefages,    on    Distribution 

of  Races 20 

Development,  Periods  of 45 

Deviation  of  Septum 278 

Diathesis 227 

Nervous 227 

Disease,  Inherited 41 

Disproportion  between  Jaws  and 

Teeth 14 

Dolichocephalic  Heads 346 

Dolichocephalic  Type 34 

Down,  J.  Langdon,  on  Cleft  Palate.896 
— —  On  Developmental  Defects. . .     9 
On    Idiocy   from    Intermar- 
riage  212 

On  Idiots 232 

On  Intemperance  as  Cause  of 

Idiocy , 214 

On  Palate  in  Idiocy 112 

— —  On  Vault  in  Idiots 327 

Dumas,  Alex .161 

Duval,  J.  R.,  on  Deformities 13 


Ear,  Development  of  Bones  of 300 

Early  Britons,  Jaws  of 67,  69 

Egyptians 27 

Engle,  on  Cleft  Palate 395 

English,  Deformities  of 32 

Epilepsy,  from    Intemperance    of 

Parents 215 

Epileptic  Pacies 176 

Epileptics,   Alveolar    Hypertrophy 

in 109 

Misshapen  Crania  in 176 

Eruptive  Fevers,  Effects  of . . .  .226,  229 

Esquimaux,  Jaws  of 68 

Ethiopians 27 

Etiology  of  Dental  Irregularities . .  15 
Europeans,  Changes  of,  in  United 

States 24 

Exercise,  Development  of    Lower 

Jaw  by 306 

Exophthalmus 296 

Exostoses  of  Vomer 270 


Face,  Development  of. 45 

Farrar,  on  Women  of  Albania 55 

Perri,  on  Criminal  Jaws 121 

Finger-sucking 476 


PAGE 

First    Molar,   Irregularities    from 

Extraction  of 448 

Fisher,  Dr.  Geo.  H.,  on  Maternal 

Impressions 218 

Fitch,  S.  S.,  on    Irregularity   of 

Teeth 5 

Fletcher,  M.  H.,  on    Disease    of 

Antrum 291 

Flower,  W.  H.,  Classification   of 

Heads 341 

On  Type  of  Head 34 

Forward  Movement  of  Teeth 465 

Fothergill,    J.    M.,    on    Strumous 

Children 227 

Fox,  Francis,  on  Thumb-sucking. .     4 
Fox,  Joseph,  on  Temporary  Teeth.    4 
Fuller,  John,   on  Dental    Irregu- 
larity    11 


Galton,  Fr.,  on  Laws  of  Heredity..  41 
Garriot,  J.  B.,  on  Deciduous  Teeth    5 

Genius 189 

Ghimes,  S.,  on  Underhung  Jaw. . .     8 
Goddard,  Paul,  on  Dental  Defor- 
mities   14 

Graham,     on     Intemperance     as 

Cause  of  Idiocy 214 

Grenser,  on  Cleft  Palate .399 

Groham ,  on  Criminals 231 

Growth  of  Maxillse 5 

Gunnell,  on  Protrusion  of  Jaws. ...  13 


Habit,  Effect  of,  on  Offspring 44 

Hampton,  Senator,  on"Red  Bones"  31 
Harbert,  S.,  on  Dental  Irregulari- 
ties    12 

Harris,  C.  A.,  on  Deformities II 

Joseph,    on     Supernumerary 

Teeth 2 

Harrison    Allen,  on  Exostoses  of 

Vomer 270 

On  Septum 251 

Harting,  C,  on  Increase  of  Bone.  ,308 
Haskell,  L.  P.,  on  Maxillary  Defor- 
mities  310,  314 

Haskell's  Deformity 313 

Hawaiians,  Skulls  of 252 

Hawley,  Dr 360 

Hebrews,  Intermarriages  Among.. 211 


IV 


INDEX 


PAGE 

Hepburn,    on      Irregularities     of 

Teeth 10 

Heredity 38 

Modified  by  Climate  and  Soil.  39 

High  Breeding 114 

Hippocrates,  on  Number  of  Teeth.  1 
Howe.  S.  G.,  on  Causes  of  Idiocy 

198,  212 

Hottentots,  Jaws  of 55,  G8 

Humphrey,  G.  M.,  on  Growth  of 

•Taw 6 

Hunt.  Dr.  Florence,    on    Jaws  of 

Swedish  Women 227 

Hunter.  Natural  History  of  Teeth.     5 

'•  Hutchinson's  Teeth" 228 

Huth.  on  Intermarriage 209 

Huxley,  on  Genius 189 

Hypertrophy  of  Alveolaj 393 


Idiocy 194 

Heredity  in 198 

Idiots,  Abnormally  Shaped  Heads 

in 202 

Brains  of 199 

Deformities  in 195,  197 

Imrie.  J.,  on  Thumb-sucking. .  .2,  .328 

Imperfect  Occlusion 320 

Importance  of  Individual  Teeth  in 

Effecting  Irregularities 4.31 

Incisors.  Central,  Importance  of.  .432 

Vicious  Eruption  of 436 

Lateral,  Malposition  of 437 

India.  Races  in 29 

Indo-European  Race,  Acceleration 

and  Retardation  in 50 

Inebriety 174 

Inferior  Bicuspid 460 

Inferior  Cuspid 458 

Inferior    Maxilla,   Asymmetry    of 

Body  of .316 

Inhalation  and  Exhalation,   Gov- 
erning Development  of  Nasal 

Bones 264 

Insanity 114 

Intellectual  Degeneracy 175 

Intemperance  of  Parents,  as  Cause 

of  Idiocy 214 

Intermixture  of  Races 26 

Ireland,  W.  W.,  on  Idiocy. . .  .194,  198 

On  Palate  in  Idiocy 112 


Irregularities     of     Teeth,     Local 

Causes  of 454 

Italians,  .Jaws  of 67 

Ivy,  R.  S.,  on  Vaults XM 

J 

•James,  Benj.,  on  Retention  of  First 
Teeth 5 

Jaws,  Abnormalties  of  from  Race 
Mixture 81 

Correlation  of  with  Extremi- 
ties    76 

Development  of 55 

Growing  Smaller 82 

Largest  Normal 55 

Measurements  of  (tables). ..58-65 

Nutrition  and  Absorption  of .  .462 

Jaw,  Lower,  Angle  of  in  Childhood  88 
Jews 27 

Hereditary  Type  of 40 

Jobson,  D.,  on  Dental  Irregulari- 
ties   r 14 

K 

Kansas,  Climate  of Zi 

Keeley  Institute,  Neurotics  in 481 

Kieman,  J.  G.,  on  Intermarriage 
of  Degenerates 480 

on  Prostitutes 163 

Kingsley,  Chas 231 

Kingsley,  Dr.,  on  Anterior  Protru- 
sion  466 

On  Palate  in  Idiocy 112 

On  Oral  Deformities 10 

Knecht,  on  Cleft  Palate  in  Crim- 
inals  399 

Koecker,  L.,  on  Temporary  Teeth.    6 
Krafft-Ebing,  on  Moral  Insanity.  .172 


Lachrymal  Duct,  Stenosis  of 298 

Langenbeck,  on  Exostoses  of  the 

Vomer 270 

On  Cleft  Palate 396 

Lapps,  Shape  of  Heads  of 34 

Left-handedness  in  Criminals 136 

Le  Foulon,  J.,  on  Thumb-sucking.  2 
Levison,  J.  L.,  on  Contracted  Jaw.  9 
Living  Persons,   Measurement    of 

.Jaws  of 66 

Local  Causes  of  Dental  Irregulari- 
ties..  4.31.  455 


INDEX 


Lombroso,  on  Born  Criminals 221 

On  Criminal  Jaw 121 

On  Prostitutes 166 

Lower  Jaw  as  Sign  of  Character. .  .484: 

Irregularities  of 415,  455 

Lydston,  G.  F.,on  Orbital  Defects . 298 
Lydston  and  Talbot,   Studies    of 
Criminals 121 

M 

McDonald,   A.   C,   on   Crania    in 

Children 120 

McLean,  R.,  on  Premature  Extrac- 
tion of  First  Teeth 7 

Mackenzie,  on  Exostoses  of  Vomer.270 

On  Septum 251 

Magitot,  on  Decay  of  Teeth 79 

Malar  Bones,  Ossification  of 46 

Mallan,  John,  on  Dental  Deformi- 
ties    14 

Manning,  Dr.,  on  Intermarriage  of 

Neurotics 480 

On  Pitcairn  Islanders 209 

Manouvrier,  on  Criminal  Jaw 121 

Marshpee  Indians 30,  31 

Martin,  Hy polite,  on  Parental  In- 
temperance as  Cause  of  Epi- 
lepsy   215 

Massachusetts,  Longevity  in 226 

Registration  Reports 225 

Mastication,  Disuse  of 80 

Maternal  Impressions 218 

Mathews,  W.,  on  Mouth-breathing.    6 
Maury,  P.,  on  Prominence  of  Jaw.  11 
Maxilla,  Inferior,  Causes  of  Asym- 
metry of 312 

Development  of,  by  Exercise.306 

Protrusion  of 821 

Superior,  Development  of . . . .  46 

Protrusion  of 318 

Maxilte,  Asymmetry  of 808,  313 

Maxillary  Bones,  Irregular  Devel- 
opment of 304 

Maxillary  Deformities,  from  Ner- 
vous Disease 177 

In  the  Insane 178 

Maxillary    Exercise,    Arrest    from 

Want  of 77 

Merrick,  Chaplain,  on  Prostitution.162 

Mesocephalic  Heads 841 

Mesocephalic  Type 34 

Migration  of  Teeth 461 


Minnesota,  Climate  of 28 

Missing  Teeth,  Frequency  of 474 

Mixture  of  Races 55 

Causing       Abnormalties     of 

Jaws 81 

Molar,  First,  Importance  of 431 

Irregularities    from     Extrac- 
tion of 448 

Molar,  Third,  Absence  of,  in  Neu- 
rotics   235 

Mongolians,  Breadth  of  Skull  in. .  77 
Mongolian  Race,  Acceleration  and 

Retardation  in 50 

Moral  Insanity 172 

Morel,  on  Degeneracy 115 

Morgagni,  on  Septum 254,  258 

Mortality  in  Cities 221 

Mortimer,  on  Dental  Irregularity.,    8 

Mosso,  on  Sexual  Offenders 231 

Mouth-breathing 17,  90,  349 

In  Idiocy,  etc 108 

Movement  of  Teeth,  Lenear 463 

Mulattoes,  Peculiarities  of 28 

Mummery,  .J.  R.,  on  Size  of  Teeth.  74 

On  Width  of  Arch 55 

Mummery  and  Nichols,  on  Teeth 

in  Savages 10 

Murphy,    Jos.,    on    Retention    of 
First  Teeth 5 

N 

Narrow  Jaws 94 

Nasal  Bones,  Development  of 46 

Nasal  Cartilages,  Excessive  Devel- 
opment of 273 

Nasal  Cavity,  Width  of 272 

Nasmyth,  on  Structure  of  Teeth. . .     3 

Nationalities,  Union  of 20 

Neanderthal  Type 75 

Negro,  Changes  in,  in  the  United 

States 21 

Negro     Race,     Acceleration     and 

Retardation  in 50 

Nervous     and     Mental     Diseases, 
Anomalies  of  Jaws  and  Teeth 

in 177 

Nessel,  Compend,  Zahnheilkunde.    8 

Nettleship,  on  Eye  Disease 297 

Neurotics,  Definition  of 115, 181 

New  England  Families,  Changes  of 
Shape  of  Head  in 35 


VI 


INDEX 


PAGE 

Nichols,  J.,  on  Dental  Deformities.    7 

Nisbet,  on  CJenius 191 

Normal   Individuals.    Deformities 

of  Jaws  in H02 

Normans  and  Danes Xi 

North  Germans,  Shape  of  Head  in  M 

Nose.  Deflections  of 274 

Nutrition  and  Absorption 462 


Occlusion,  Perfect 4()1 

Ocular  Affections  from  Deformed 

Orbits 206 

Open  Mouth,  Sleeping  with 6 

Optic  Neuritis 296 

Orang  and  Negro,  Jaws  of 19 

Orbit.  Form  of 149 

Orbital    Deformity,   Eye    Disease 

from 297 

Orbits,  Neuroses  of  Development 

of 293 

Variations  of 293 

Originaere  Verruecktheit 175 

Orthognathism 50 


Parmley,  Lectures  on  Teeth 5 

Partial  V-shaped  Arch 357,  358 

Percy,  B.aron,  on  Maternal  Impres- 
sions   219 

Perfect  Occlusion 461 

Periods  of  Development 45 

Peruvian  Skulls,  Septum  in.  .258,  263 

Plates,  after  page 487 

Polynesians,  Jaws  of 68 

Population,  Concentration  of 225 

Premature  Extraction   of  Tempo- 
rary Teeth 6 

Prendergast,  Patrick  Eugene  Jos.. 158 
Prognathism 50,  326 

In  Negro 51 

Prostitutes,  Anomalies  in 169 

Ears  of 164 

Skulls  of 164,  167 

Stigmata  in 162 

Prostitution  and  Degeneracy 161 

Protrusion  (anterior)  of  Teeth 465 

Puritans 55 

Putnam,  Prof.  J.  W 30 

Pyncheon,  Dr 360 

Q 

Quelmalz  &  Schultz,  on  Septum..  .254 


Races,  Pure 27 

Intermixture  of 26 

Rami,  Asymmetry  of 315 

Rearing  of  Degenerate  Children.  .484 
Recklingshausen,  Von,  on  Crania.  167 

"Red  Bones" 31,  32 

Rengger,  on  Paraguay  Indians. ...  7() 

Retardation  and  Acceleration 50 

Retention  of  Temporary  Teeth ....     4 

Reversion,  Local 118 

Reversional  Tendencies 207 

Rickey,  on  Dental  Anomalies 473 

Rigg's^Disease 79 

Robertson,  ^V.,  on  Dental  Deform- 
ities    11 

Ross,  H.  D.,  on  Correction  of  Teeth    4 

Rotation  of  Teeth 465 

Royal  Families,  Degeneracy  in . . .  .482 
Royalty  in  England 42 


Saddle-shaped  Arch, 15,  .354, 419 

Description  of 424 

Modification  of 424 

Of  Lower  Jaw 4.30 

Salter,  Thos.,  on  Thumb-sucking..     4 

Samboes 29 

Savages.  Acuteness  of  Senses  in . . .  77 
Scandinavians,  Decay  of  Teeth  in.  22 

Schaus  &  Welcker,  on  Septum 255 

Scott,  Jos.,  on   Dental   Irregulari- 
ties       7 

Semi-saddle  Arch 857 

Semeleder,  on  Septum 251 

Semi- V-shaped  Arch 357,  413 

Senses,  Acuteness  of  in  Savages. . .  77 
Septum,  Deflection  of  by  Air 265 

Deformities  of 251 

Development  of 258 

Deviation    of  Dependent    on 

Development     of      Adjacent 

Bones 278 

Fracture  of 256 

Molded  by  Aspiration 276 

Relation    of    to    Turbinated 

Bones ..261 

Sewell,  H.,  on  Dental  Irregularity.  14 

Sexual  Degeneracy 171 

Shirley,  on  Interbreeding  in  Deer. 211 
Shorthorn  Cattle,  Interbreeding  in.210 


INDEX 


Vll 


rAGB 

Short-sight  in  Watchmakers,  Sail- 
ors, etc 76 

Shuttle  worth,  on  Development  of 

Idiots 200 

On  Parental  Intemperance  as 

a  Cause  of  Idiocy 214,  216 

Sigmund,    on     Irregularities     of 

Teeth H 

Skulls  of  Criminals 137 

Sollier,  Alice,  on  Dental  Anomalies.483 

South  Americans,  Jaws  of 68 

South  Germans,  Shape  of  Heads 

of 34 

Spaces  Between  Teeth 464 

Sphenoid,  Development  of 9 

Spooner,  E.,  on  Dental  Irregulari- 
ties       7 

Stenosis  of  Lachrymal  Duct 298 

Stigmata,  Frequency  of 248 

Stockton,  Dental  Intelligence 3 

Stockton-Hough,  on  City  Life 221 

Supernumerary  Teeth 1,  469 

Sutton,  Bland,on  Cleft  Palate  395,  379 

Suture,  Deformity  of 385 

Swedes,  Jaws  of 67 


Talbot,     on     Dental      Irregulari- 
ties   15,  16 

Talbot  and   Lydston,   Studies  of 

Criminals 121 

Tarnowsky,  on  Atavistic  Character 

of  Teeth 482 

On    Cleft.  Palate   in  Prosti- 
tutes  399 

On  Facial  Anomalies 232 

On  Prostitution 162 

Tartar  on  Teeth,  from  Want   of 

Function 468 

Teeth,  Atavistic  Characters  of 482 

Changes  of  Position  of 107 

Direction  of  in  Normal  Vault.  393 

Forward  Movement  of 465 

Insertion  of 101 

Irregularities  of.  Causing  De- 
formed Vault 394 

Linear  Movement  of 463 

Local  Causes  of  Irregularities 

of 431 

Migration  of 461 

Rotation  of .465 

Size  of 73 


Teeth,  Spaces  Between 464 

Teeth  and  Jaws,  Waste  and  Repair 

of 462 

Temporary  Teeth,  Premature  Ex- 
traction of 6 

Retention  of 4 

Theile,  on  Exostoses  of  Vomer ....  270 

On  Septum 251 

Third  Molar,  Absence  of 235 

Thompson,    on    Development     of 

Face 18 

Thornton,  W.,  on  Dental  Irregu- 
larity      8 

Thumb-sucking 2 

As  Cause  of  High  Vault 328 

Deformities  from 478 

Thumb  and  Finger  Sucking 476 

Tiedemann,  on  Cleft  Palate 395 

Tomes,  C.  S . ,  Dental  Surgery 6 

On  Decay  of  Teeth 78 

On    Faulty  Development    of 

Alveoli 106 

On  Size  of  Molars 74 

Trendelenberg,  on  Septum 254 

Tschuvashes 29 

Tuberculosis,  in  Relation  to  Nasal 

Deformities 279 

Turbinated  Bones,  Arrest  of  Devel- 
opment of ...263 

Excessive      Development    of 

259,  260,  268 

Tylor,  on  Intermarriage 210 

U 

Underhung  Jaw 2 

Undeveloped  Teeth 474 

V 

V-shaped  Arch 15,  353,  401 

Description  of 408 

Formation  of .403 

Modifications  of 410 

Vancouver  Island  Indians,  Skulls 

of 263 

Vault,  Anatomy  of 84 

Antero-posterior  Diameter  of .  69 

Date  of  Deformity  of 383 

Development  of 84,  257,  379 

Developmental  Neuroses  of.  .327 

Grooves  in 390 

High     and     Contracted,    in 

Idiots 115 

Height  of 71,  90 


Viii  INDEX 

PAGE  PAGE 

Vault,  Height  of.  in  the  Insane ....  95      Weber,  M.  J.,  on  Cleft  Palate H95 

.^  .  92      Weissmann,  on  Heredity 116 

IZ  NormalDevelopmenVof;::::  86  West  Indies,  Habitability  of . . .  .2^,  24 

Rideesin                    387  White,  J.  ^V.,  on  bucking  lingers.     4 

_-  Shape  of  Compared  to  that  of  White  Race  Shape  of  Head  in    . . .  ;M 

„     ,                                           34Q  White  and  Stellwagen.  on  I'alate  in 

Standard  of  Measurement  of.  94  Idiots^. .  112 

Width  of    51,66,96      ^Vhltney.  Dr.J.M 2o2 

Vogt.  on  Diameter  of  Head 340  Wilbur,  C.  T.,  on  Intemperance  as 

Vomer,  Deflection  of  by  Air 265  a  Cause  of  Idiocy. ^214 

Ossification  of .50  Wilmarth,   A.,  on    the  Brains    of 

Projections  of 269  Wiots  19. 

Relations    of,  to   Turbinated  Winckworth,    on    Supernumerary 

Bones 261  Teeth 2 

Von  Graefe,  on  Optic  Neuritis 297      Wisdom-teeth,  Size  of /3 

Z 

w 

Ziem,  on  Development  of  Nasal 

Waite,  G.,  on  Dental  Irregularity..    5  Cavity • 275 

Walther,  on  Cleft  Palate .396      Zuckerkandl,  on  Septum 251 


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